Over the past decade efforts have been made to develop support services that would allow elders to remain in the community longer and avoid the expense and indignity of nursing home placement. These alternatives typically focus almost entirely on the physical problems of aging. However, many of the debilitating problems of old age are mental in nature and require specialized diagnosis and treatment. In response to its shocking geriatric suicide rate, tied inextricably to isolation and mental illness, Spokane County, Washington, in collaboration with Eastern Washington Area Agency on Aging, initiated Elderly Services. It has effectively decreased the rate of suicide among the elderly from 28 to 16 per 100,000 people, and improved the quality of life of hundreds of aging residents.
The goals of Elderly Services are to decrease nursing home residence by increasing home care, identify marginalized elderly who may be high risk and without a support system, and the integration of a solid mental health component to all home care services. In an effort to broaden the scope of elderly services, provide more comprehensive and appropriate services, and reduce the number of elderly receiving residential care, Elderly Services has designed a multi-pronged approach that includes outreach together with integrated and specialized services.
Across Spokane County six interdisciplinary teams composed of 18 clinical case managers, six team leaders, several registered nurses, one psychiatrist, a family physician and a clinical coordinator provide in home evaluation, care planning, treatment, and clinical case management. Elderly Services also provides a 24-hour crisis response telephone number as well as an information line for high-functioning elderly.
Perhaps the most innovative element of Elderly Services is the Gatekeeper program. Designed as a dynamic outreach and identification procedure, the Gatekeeper program systematically trains community members who would who have natural interactions with elderly residents. Often holding these proactive community posts are police officers, firemen, meter readers, pharmacists, supermarket employees, librarians, apartment managers, bank tellers, building inspectors, ambulance employees, fuel company clerks and mail carriers. These individuals act as feelers in the community and are careful observers of elderly residents' status. For the truly isolated elderly who have no family to advocate for them, a Gatekeeper may be the only individual with the knowledge, skills and desire to refer them to services. Gatekeepers often act as the main links between elderly people who don't possess full control of their mental or physical faculties and have no family, with the home care or residential services they need.
According to site evaluator Barbara Salisbury, Administrative Dean of the Kennedy School of Government, while many jurisdictions have addressed the issue of access to home care and mental health services for elders, there aren't any that have dealt with both issues in as effective a manner as Elderly Services. The integration of mental health components with home care, as well as the innovation of community outreach regarding services, has allowed many more elderly people to stay in their own comfortable space during the last years of their lives while receiving comprehensive services. Additionally, hundreds of at risk elderly, many of whom are without family or homes, have been positively identified and placed in appropriate facilities. The safety and dignity of the elderly have been preserved by Elderly Services and, as the nation moves into an era of increasing elderly population, it will serve as a steady policy paradigm.