Older adults sometimes go to mental health centers or seek private psychotherapy through referrals. General practitioner, usually fail to detect depression in older patients. This situation may be due in part to inadequate geriatric training for medical professionals. The reimbursement system used by many healthcare providers may pose some problems as well, for it is biased towards inpatient care and pays less for outpatient therapy specially for mental health services.
The prevalent myth regarding nursing homes is that families dump their older relatives into these institutions at the first sign of frailty. However, families usually explore all their alternative and exhaust their own resources before they institutionalize an older relative. Thus, the decision to institutionalize comes as a last resort not as a first choice. Nursing homes are now the major locus for institutional care for older adults with severe chronic illness and mental disorders. Given projected future needs, it does not appear that enough people are being trained to provide mental health services within nursing homes.
Alternative Living settings: Recently, there is a dramatic rise in assisted living, a viable alternative to placement in nursing homes for many older adults who require assistance of one sort or another. In contrast to nursing homes assisted living facilities reassemble hotels, with separate rooms and suites for the residents as well as dining rooms and on-site amenities such as beauty and barber shops. The philosophy of assisted living stresses autonomy, independence, dignity and privacy. In addition to assisted living facilities and nursing homes, continuing care retirement communities (CCRCs) of a full continuum of care which enables residents to move from one housing option to another depending on their needs. CCRCs are type of facility that combines independent living, assisted living and nursing homes together by having all the facilities on the same grounds.
Community based care: some communities and for-profit agencies are organized to provide various services such as:
- telephone reassurance, daily phone calls to older persons living alone to check that they are alright
- home services, such as meals on wheels, which brings a hot meal each day the person’s door;
- home visitors, visits from volunteers who cook meals and do household chores;
- Shopping help and light repair work by volunteers;
- senior centers, which may also serve hot lunches and provide help with slate- and federal forms, and also opportunities for socializing;
- sheltered housing, apartments in which several old people may live together semi-independency;
- home visits by health professionals and social workers who can assess the actual needs of old people and treat them;
- regular social visits from community and neighbors;
- adult day services, which provide a variety of health and social service in a day time group setting;
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