Broken Hearts: The Impact of Prescription Drug Abuse on Seniors and Their Support Systems

Transcription

1 Broken Hearts: The Impact of Prescription Drug Abuse on Seniors and Their Support Systems Debbie Gulley, RN and Kaye Inoshita, RN Area Agency on Aging District 7, Ohio

2 Objectives: Learn strategies one AAA employed to engage in discussions with an addiction services provider to improve services for the senior population. Engage in dialogue with other aging service providers to learn how seniors in their region have been impacted by prescription drug abuse and develop ideas for protecting seniors. Explore how the NCOA Get Connected curriculum can be used to improve awareness and skills of professionals serving both seniors and persons with addictions.

3 The Area Agency on Aging District 7 covers 10 counties in southern Ohio.

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5 Increased Exposure Increased Rates of Substance Abuse Epidemic or Crisis We are Currently Fighting

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10 Amount of prescription painkillers sold by state per 10,000 people (2010) SOURCE: Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), 2010

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16 Other Results of Prescription Pain Pill Addiction and Abuse

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19 What About Seniors and Drug Abuse? Report from Johns Hopkins on Drug Abuse and the Elderly noted that a study in the Annals of Epidemiology projects that the number of people age 50 and older abusing prescription drugs could increase 190% over the next two decades (2.7 million in 2020).

20 Signs of Drug Abuse May Be Difficult to Detect in Seniors Myth - it is not a senior problem. Symptoms similar to signs of other illnesses or aging. Falls - alcohol or drugs not usually explored as a causative factor.

21 Care Plans Often Difficult to Implement Clients believe they have it under control. (A nursing home stay where they do not have access to drug of choice) Denial Hiding addiction Refusing counseling services. Manipulative behaviors No family support/fractured personal relationships

22 What are the Effects of the Prescription Drug Abuse Epidemic That We Have Observed? Some seniors have difficulty acquiring meds/prescriptions which they legitimately need. Our seniors have become targets for crime. Shortage of home health care workers. Abuse/exploitation from family members. Grandparents raising and caring for grandchildren. Grief and emotional upheaval/betrayal. Some seniors have become addicted and/or are involved in drug trafficking.

23 Case Study Elderly male nursing home (NH) resident completed Home Choice (HC) application to transition from NH to community setting. Alert, oriented and own decision maker. Estranged from son. Daughter not supportive of transition. Client mentions nothing about addiction to alcohol during first visit with AAA7 RLTCOP Transition Coordinator (TC). Daughter expresses concern to TC. During first discharge planning meeting, client denies alcohol abuse but says he needs two shots before dinner and two shots after. Refuses addiction counseling or services. Daughter very upset about father leaving NH - says he has been drinking at the nursing home. NH social worker (SW) denies resident ever to be intoxicated and never smelled alcohol on his breath. TC met with resident again to discuss possible alcohol addiction and importance of a safe and successful transition. Client agreed to talk to a counselor from Behavioral Health Services. Behavioral Services visited in NH but would not follow into the community.

24 Case Study (continued) SW failed to follow-up on referral and client discharged to home without counseling services. TC locates new counseling/addiction agency to provide client support and addiction counseling. Before agency sees him, client is admitted to hospital with UTI/MRSA and COPD. Client tells TC that ER doctor said he was in DTs, client continued to deny. Spends time in hospital and back to NH. TC contacts new counseling/addiction agency about client s current status and they agree to visit him in NH. Counseling agency visits client at NH and TC arranges with CM for additional PASSPORT hours per day as well as a Community Support Coach.

25 Case Study (continued) TC talks to client before discharge back to home from the NH about his excessive drinking, which he denies again. Client was home three days, passes out, and is sent to ER with COPD, weakness and ETOH. Client reports to TC he only had one drink. Returns home and addiction counselor begins to make regular visits. Client continues to deny drinking excessively. Client in and out of hospital and NH from 6/28/10 1/11/11, when he returns to NH for good.

26 Case Study #2 Elderly female nursing home (NH) resident with limited family support completes Home Choice application to transition from NH to community setting. On initial visit, client told the AAA7 Regional Long-Term Care Ombudsman Transition Coordinator (TC) that she didn t want to live with her husband (legally separated). She said her husband was taking care of their son with mental health and addiction issues and was in and out of jail. She shared that she wanted to live several counties away from them. TC finds an apartment for the client and then client asks if her husband can live with her, but she changes her mind again before discharge from the NH.

27 Case Study #2 (continued) One month after transition, the TC finds the client does not have the money to pay her second month s rent payment. Client reported that she gave her husband the money from her check to buy a car. Client receives an eviction notice. TC calls apartment manager and finds client s husband and son were intoxicated with another tenant, client s next door elderly neighbor, and a prostitute. An argument and altercation ensued between son and neighbor. The police were called and son taken to jail. Now, elderly neighbor afraid to live in his apartment for fear of personal safety. Client admits that she gave her husband the money for and co-signed for a car, then he left and never returned.

28 Case Study #2 (continued) TC advocates on behalf of client to help her from being evicted from apartment and obtains HC emergency funds to pay two months rent for client. Client is permitted to remain in the apartment until other arrangements can be made. TC discusses living options with client and she chooses to complete an Assisted Living Waiver (ALW) application. She later moves to an assisted living facility with the assistance of her AAA7 ALW CM. TC educated client about available support groups and services for those with family members addicted to drugs.

29 What is Our Strategy for Working with Seniors in These Circumstances?

30 Collaboration with Compass Health/ The Counseling Center

31 Curriculum can be downloaded at:

32 Getting Started: Step 1 - Assess your Organizational Strengths and Challenges Step 2 - Identify Resources for Staff and Seniors Step 3 - Educate Staff Step 4 - Educate Older Adults Step 5 - Plan Future Developments

33 Presenters: Deborah Danner-Gulley, RN, BSN, CMC Director of Care Management Services Area Agency on Aging, District , ext dgulley@aaa7.org Kaye Mason-Inoshita, RN Regional Long Term Care Ombudsman Program Director Area Agency on Aging, District , ext kinoshita@aaa7.org