PSR and Older Adults Jim McMinn, RSW Debra Walko, RSW LOFT Community Services September 23, 2010

1. PSR and Older Adults Jim McMinn, RSW Debra Walko, RSW LOFT Community Services September 23, 2010 Hope and Recovery

2. LOFT Community Services (Leap of Faith Together) A non-profit community service organization which offers a system of integrated permanent housing, housing support, community case management and community outreach to vulnerable individuals (youth, adults and older persons) in the Greater Toronto area. LOFT Community Services offers services to over 3,500 vulnerable and homeless people at more than 65 sites. The majority of these individuals have mental health, substance misuse and homelessness challenges.

3. Our Program Sites Crosslinks Seniors Housing and Support Services 310 Seniors John Gibson House & The Stepping Stone Project 75 Seniors St. Anne’s Place 110 Seniors Dunn Avenue Supportive Housing Services & Dunn/Spencer 85 seniors College View Supportive Housing & Simon Apartments Seniors’ Services – 95 Seniors

4. Overview of LOFT’s Seniors’ Programs & Services • Our Residents are culturally diverse older adults and seniors living with issues such as serious mental illness, addictions , major physical health concerns, severe social isolation, poverty, and homelessness. • At each location we provide 24 hour on site services which include : •  Personal Care -  Ethno Cultural Services •  Medication Reminders -  Dining Services •  Meal Preparation -  Crisis Intervention •  Emergency Response -  Affordable Housing •  Escorts to Appointments -  Case Management •  Care Giver Relief -  ED/ALC reintegration housing & support •  Essential Housekeeping •  Laundry •  Social/Recreational Activities

5. New Component to our Programs Emergency Diversion and Alternate Level of Care (ED/ALC) reintegration/transitional housing and support • The Stepping Stone Project and Crosslinks Seniors offer transitional support and housing for seniors who are in ALC beds or Emergency Department. • These seniors transition into our permanent supportive housing, their own home or other housing in the community.

6. New Component to our Programs Emergency Diversion and Alternate Level of Care (ED/ALC) reintegration/transitional housing and support • CAMH • TCHC • CCAC • Downsview Services to Seniors • Humber River Regional Hospital Formal Partnerships

7. Ages of the Residents We Support

8. Ethnocultural Diversity of Our Residents

9. Individuals Living with Serious Mental Illness and Addiction

10. Mental Health Demographics

11. Inter-RAI CHA Assessment Index Pilot Results Inter-RAI CHA Assessment Index Pilot Results InterRAI CHA Assessment Index Pilot Findings Primary Diagnosis: Schizophrenia (5), Bipolar Disorder (2), Depression (4), Dementia (2), Alcohol Misuse (1), No mental illness (1). Cognitive Performance Scale: Intact (2), Borderline intact (5), Mild impairment (6), Moderate impairment (2). Depression Rating Scale: No depression (5), Some symptoms (6), Possible depression (3), Severe depression (1). IADL Involvement Scale: Limited assistance required (3), Extensive assistance required (1), Dependant (9). CHESS: Stable (3), Low level of medical complexity (6), Mild level of medical complexity (6). Self-Reliance Index: Reliant (1), Impaired (14). Pain Index: No pain (7), Mild (4), Moderate (2), Excruciating (2). MAPLe Score: Moderate priority (5), High priority (5), Very high priority (5). Average score: 4 (High priority). ADL Self-Performance Scale: Independent (5), Supervision required (2), Limited impairment (2), Extensive assistance required level I (3) and level II (2), Dependant (1).

12. Staffing Model • Supportive Housing Services Staff Team is made up of: • Personal Support Workers • Senior Personal Support Worker • Community Support Workers • Coordinator of Services • Program Director

13. Staff Roles Personal Support Workers: • Provide daily support, crisis intervention, psychosocial support, play a key role in proactive support. Senior Personal Support Worker: • Ensures the daily schedules occur, distributes information, ensures “all the bases are covered”. Community Support Worker : - provides case management, crisis intervention and psychosocial support. Coordinator of Community Support Services : - to oversee and monitor day to day service delivery and coordinate internal and external client services Program Director : • Administers and coordinates program, provides service coordination, provides front line support.

14. Why talk about PSR/Recovery Approaches with Older Adults? • To look at how a practical, on site support model can be an integral part of the support network to help keep people living with mental health and substance misuse issues living in their own home. • To demonstrate how such a model is an ideal complement to clinical and community supports. • To discuss how this type of support is a “missing link” in keeping many people living with these challenges in housing. • A new way to look at staff positions and seniors’ supportive housing.

15. So if Recovery is….. • “……a journey. It is the path traveled by people with psychiatric disabilities as they move toward their life goals.” • It is a “Wellness Model”.  Recovery 101. Recovery. October 18, 2003. Available online: Spokane Recovery Index.html

16. And if Characteristics of an Effective Wellness Model are…….. • “It concentrates on wellness rather than illness. • It is informative and instructive with some structure. • It instills hope so that persons can feel that their thoughts/symptoms are not unique. • It provides a safe, welcoming environment and offer comfort and acceptance. • It offers the opportunity to help others; this makes one feel good about one’s own self. • It helps develop a sense of personal responsibility • It recognizes the patient’s right to self-determination”  Recovery Inc.: A Wellness Model for Self Help Mental Health. October 23, 2003. Available online: recovery-inc.com/resources/sach.pdf

17. How LOFT applies the Recovery/PSR Model to our Supportive Housing Programs for Seniors • Working with people “where they are at” • Following peoples’ lead. • Using a “hands on approach” • An emphasis on building community and social connections. • Reinforcing the concept of Hope.

18. A Community of Unique Individuals….. • Working with each person using the Recovery Model as they travel on their own journey by: •  Being Flexible •  Being Creative •  Being Accepting •  Being Supportive •  Remembering Individuality •  Maintaining Hope

19. The Importance of Integration of Support ~ Building a Community Around an Individual • There is an “internal team” as well as an “external team”which are equally important and complement each other well. • It is crucial these “teams” work together. • Supportive Housing Programs are natural “eyes and ears” for the clinical supports. • Supportive Housing serves well as a communication hub and clearinghouse. • Supportive Housing fills the gap that sometimes exists in community support.

20. Sometimes Bricks and Mortar are not Enough! • For many older adults living with mental illness and addiction challenges, affordable housing is a necessity and many of these seniors want and need on site practical support directed by them. • There is a “gap” in services!

21. How Does Supportive Housing Fill the “Gap”? • 24 hour psychosocial support • 24 hour crisis intervention • Can be the “hub” or clearinghouse for communication because we are on site • Can be proactive on a daily basis • Excellent opportunity for case finding for outside supports and resources • Regular medication monitoring • Escorts and support at appointments • Liaising with hospitals

22. How Does Supportive Housing Fill the “Gap”? • Harm Reduction • Increased ability to maintain housing • Daily monitoring of all ADL’s including nutrition, condition of the home, personal hygiene etc. • Excellent complement to clinical supports • Advocacy in tenant/housing related issues • Offering cultural support and breaking down cultural barriers • Building a healthy, diverse and tolerant community within the community

23. What are the challenges from a PSR/Recovery Model specific to seniors? • Many of the older adults/seniors we work with have been through a system where they weren’t offered choices – so this is new! • Because many are living with serious and chronic physical illness – we are challenged by the consequences of choices • When there is a question of capacity for decision making • The rest of the “system” doesn’t work in this model – a challenge for both the senior and us!

24. What are the Challenges?? • Establishing and maintaining connections with the “external team”. • Everyone is different! • Different perspective on Personal Support Worker Role as well as other staff ie. dining room, housekeeping etc. • Working with other housing providers. • Individuals leaving the “path” of their original plan.

25. How Do We Overcome these Challenges? • Constant Networking • Establishing Interagency Groups • Be willing to be the “hub” • Be open minded, creative and flexible • Training, training, and more training! • Be very team focussed • Be proactive and communicate with the housing providers. • Work closely with the individual and their clinical and community supports to come up with new versions of the plan.

26. To Contact Us: Jim McMinn 416 537-3477 x 222 jmcminn@loftcs.org Debra Walko 416 259-7117 dwalko@loftcs.org