Thank you. Cynthia, you did mention something about the service in South Philadelphia and you are not allowed to go into the homes?
This is a program funded by the Philadelphia Corporation of Aging through their program management department and the contract is to be accessible to the referrals from the six senior centers that are in South Philadelphia; however, we are not allowed to go into the in-home area.
Right. We work with the senior centers. Actually we have one clinician who is extremely busy with just the five centers that she visits doing assessments as well as treatment and doing health promotional activities for the folks who come there.
So if anyone needs 105 5/12/03 - Health/Human Services - Resolution 030174 some followup services, they would have to come back to the centers, right?
Right. However, there are some occasions when someone is referred from the senior center. Sometimes people don't want to be seen there either for a lot of reasons. They feel their friends may know they are talking to the professional. We will meet them wherever. Sometimes it is in the coffee shop. Sometimes it's the library. Sometimes it's in their home. We pretty much try to look to what helps the client.
I'm sorry. I don't mean to monopolize this. Any other questions or comments?
You mentioned $350,000, $1.30 for every older adult in the City. As Mary Hurtig shared with us, the one recommendation Council could act upon, in your view if you had a wish list and you only got one wish, what could we as Council do to impact this issue?
I think the plan that we have mentioned which would expand to all the whole City services, and part of that 350,000, most of it, would go for therapists. But part of the whole idea 106 5/12/03 - Health/Human Services - Resolution 030174 is that it is not just finding the therapists and putting them out there, but it is the connecting and it is the coordinating that is built into the program. So I would say that.
There is a summary of the plan that you should have received.
And there is a 20version which we made available, and if you would like us to send it to you, we can do that.
We probably have it. We are in the middle of budget hearings at the same time, so we will get to it and certainly, as I said, the record is open on this. So we won't close it out today. Certainly we will need to come back and have further discussion and we will look at the plan. It's probably here. Yes, we have it. After the 20th you can get our attention, okay? 107 5/12/03 - Health/Human Services - Resolution 030174
Let's go to the next group, Mary Ann Wall and Vergi Viacava. We would like you all to summarize your testimony.
My name is Mary Ann Wall. I'm program director at Catholic Social Services for HOPE, Homebound Outreach Program for the Elderly. I thank the Council for giving me the opportunity to present testimony on the needs of Philadelphia's older adults. My comments today will address the clients seen by Catholic Social Services behavioral health accessibility team, renamed the HOPE team that has been referred to here prior to my testimony today. I am sure you are aware of the long history of service that CSS has of providing services to senior citizens at its five senior centers in Philadelphia. In addition, CSS also provides help to individuals of all ages and their families through our network of family service centers, three of which are located in Philadelphia. All three of these family service center sites in Philadelphia are licensed by the Commonwealth of Pennsylvania as outpatient psychiatric clinics. Catholic Social 108 5/12/03 - Health/Human Services - Resolution 030174 Services was one of the two organizations designated as a recipient of the reinvestment funds available to provide services for homebound senior citizens with behavioral health needs. The HOPE team is comprised of a full-time program director -- that's myself, and I'm also a clinical social worker -- and a full-time clinical social worker, full-time case manager, full-time secretary and a consulting psychiatrist, all of whom are aware of the mental health needs of senior citizens and myself and the case manager have been through the program referred to here, which is a joint project between Philadelphia Appropriation for the Aging and also the Office of Mental Health. It is important to note that although the Office of Mental Health requested that the HOPE team concentrate its efforts on Northeast and Far Northeast Philadelphia, it currently has on its rolls clients in South, Southwest and West Philadelphia. Part of the original requirements were that the team accept referrals from throughout Philadelphia and we have assessed and provided services to clients where other services do not exist. As I would go on to say, this becomes 109 5/12/03 - Health/Human Services - Resolution 030174 problematic given the limited number of folks on the team. The mental health service provided is primarily individual in-home therapy for clients with various depression, anxiety and adjustment problems. The case manager provides services to the clients who do not already have case managers from other agencies. The logistics of providing in-home therapy, though, greatly reduces the number of clients that can be seen in a day especially with the geographic distribution we have with our ongoing clients. That's why it's really important that there be more teams available to serve the entire area of Philadelphia, the entire county, and that it not be just focused in a few areas. Since the program began in July of 2000, over 300 referrals have been made to the program. Over 120 clients have been seen for behavioral health services on an ongoing basis. We maintain 30 to 40 open cases at any given time. Some of these referrals resulted in in-home assessments which did not become active cases because the person was not eligible for services or changed their mind about receiving services. We currently have 17 people 110 5/12/03 - Health/Human Services - Resolution 030174 awaiting in-home assessments. The interaction of changing situations, changing physical conditions and capabilities and loss of family, friends and functioning often combine to confront our clients with what seems to them insurmountable problems. The HOPE team is able in many instances to provide information about new resources and assistance in understanding the rationale for change and the positive impact that change may have. In summary then, I believed in the concept of behavioral health accessibility teams at the point we developed the proposal.
With nearly three full fiscal years of operational experience, I continue to believe it is a much needed and valuable service. I believe the continuation and expansion of this program will provide needed behavioral health services to the homebound elderly. This will result in few psychiatric hospitalizations, medical hospitalizations, and will allow some people to take advantage of existing outpatient services as they overcome their accessibility barriers. I believe this can only be accomplished if the Office of Mental Health and the Philadelphia 111 5/12/03 - Health/Human Services - Resolution 030174 Corporation for Aging work effectively and efficiently together to meet this end. With the need for such services throughout Philadelphia, we could more efficiently provide services if each section of the City were served by such teams as HOPE and Interac's in-home services to older adults. Thank you for allowing me to present these comments.
Thank you. Next? Please identify yourself for the record.
I appreciate very much the opportunity given to me to testify this afternoon on behalf of COMHAR and the Latino population. My name is Vergi Viacava, and I work as a mental health clinician for COMHAR, which is a community mental health and mental retardation center that was incorporated in 1975. It was funded by a contract with the City of Philadelphia, the Department of Public Health, Office of Mental Health and Mental Retardation as well as the Commonwealth of Pennsylvania and the Federal Government. The OATS 112 5/12/03 - Health/Human Services - Resolution 030174 program, Outreach, Assessment and Treatment Services, began in January 2000 and is funded by the Pew Charitable Trust. OATS provides services to elders 60 years and over residing in the north and northeast areas of Philadelphia with great emphasis in providing services to the Latino community who have already primary mental health diagnosis. Our mental health services are provided to the elderly in their own homes, in housing projects, churches, senior centers. We provide as well psychoeducational groups in various senior centers and churches. Groups provide a very safe environment without the stigma attached of being identified as having mental health issues. We provide as well caregiver support and educational sessions in their own homes not only to help them to learn about signs of depression, but to enhance their caregiver role. Many of our elderly are Latinos, as I said, and one of the reasons why the Latino population has very -- I shouldn't say "very," but limited involvement in the mental health system is because there is a stigma attached to it and, therefore, many of them become withdrawn and 113 5/12/03 - Health/Human Services - Resolution 030174 isolated. We feel that greater exposure to programs such as ours are essential to the Latino community. Latinos will care for their own families. They very much love and they will care for the elders, but oftentimes they are not able to recognize signs of depression and mental illness and that also applies to health providers and oftentimes they fail to refer them for proper treatment. I would like to share with you a couple of statements that were made by two of the wonderful elders that we serve. One comes from an elder that attends the support groups, the psychoeducational groups, and she has been participating in the groups for a few months. She had suffered from anxiety and depression and after a few months of being a part of the group and participating very actively, she came with a very poetic statement and I'm going to read it to you. "Let me shine. Let me live each day at a time and show you that I can still shine because I'm here and I'm a part of this group. I belong. " 114 5/12/03 - Health/Human Services - Resolution 030174 The next one is from a statement from a homebound client that had suffered overwhelming losses and they came very quickly and abruptly, didn't have time to process them, and their losses were related to physical functioning, deterioration of her health, loved ones, loss of loved ones, productivity, mobility. After a few months of individual counseling she was able to work through with her losses and her feelings and she found the courage to learn to love herself again and love life itself and she quoted the following: "And all this time I couldn't smile or perhaps I had chosen not to smile. These years I fool myself, believing that I couldn't talk freely, that I refused to have pictures taken of myself. I refused to socialize because of my facial paralysis. I learned today with very much support, love and being allowed and given permission to express my joy and my sorrow. I learned that I can smile and my smile comes from deep in my heart. I learned that I can smile. Today I talk, I smile, and my family can take a picture of me. I learned that I'm beautiful and I'm lovable and I'm capable.
" 115 5/12/03 - Health/Human Services - Resolution 030174 These are only two of the wonderful cases that we have and those clients, I want to mention, they really wanted to come here and I'm very blessed to have two of my Latino clients here. I want to thank you then. Philadelphia ranks at the top among the country's largest city in its percentage of residents over 65 years of age. It is crucial to take into consideration that the Latino elderly are the fastest growing groups with pockets of extreme poverty. They come from a very, very large percentage of the group, the large amount of elderlies in this City. There is a crucial need for expansion of mental health services, social services, art therapy programs, assisted living facilities for Latinos that are deteriorating in their health, but we need integrated services. And also we have to take into consideration that these programs also need to be made culturally sensitive. For organizations that are providing support for mental health consumers, the ability to reach out effectively and appropriately to elders of different cultural backgrounds is crucial, is central to meeting the needs of such a diverse 116 5/12/03 - Health/Human Services - Resolution 030174 community. It is very important also the hiring of mental health clinicians, bilingual and bicultural. As the aging population increases, so does the number of people who face caregiving responsibilities and the issues of loss are very inevitable. We need services for Hispanic caregivers. There are not caregiver support groups in the areas we serve. Materials need to be translated in Spanish and we need as well Spanish hot lines. Our strong presence is very much needed in the community, in the Latino community, to help the growing population with the challenges they face and they will face. Let us nurture our community through recognition of their diversity and acknowledge the multiple and various needs they have. Let us help to offer services that we promote their ability to our elders to remain in their homes, in their community, to be functional and to prevent costly institutionalization. Our mission as providers in the community is to do the best, the best that we can in serving our older adults with a lot of compassion and to serve this population and to be aware and to keep in mind that death doesn't come with old age 117 5/12/03 - Health/Human Services - Resolution 030174 but in fact death comes with the fact that someone is isolated, neglected and forgotten. Thank you very much. )
Thank you very much. We appreciate your testimony. When you talk about having more staff for --
I'm not on the docket, but I work with Vergi. I'm her supervisor. I'm with COMHAR. My name is Gary Schoenberg and my title is director of continuing care services and I'm also the project director for the OATS program, which is funded, as Vergi had mentioned, through the Pew Charitable Trust. I just wanted to emphasize the funding for this program is two years at a time. We get $130,000 from the Pew Charitable Trust for providing outreach services to the elderly, mental health services to the elderly. This funding is in jeopardy because it only goes for a two-year period of time. The services for this program which has been running since 2000, January of 2000, is in jeopardy, constant jeopardy of being cut. The program is designated to be over December 31, 2003. 118 5/12/03 - Health/Human Services - Resolution 030174 We do not have any sure recognition or we don't have any verification that we will continue getting funding. It is a grant that requires continuing to rewrite and resubmit a grant application.
No, from the Pew Charitable Trust is where the funding from this comes. The concern is the level of jeopardy. We service approximately over 250 clients over a two-year period of time. A majority of these individuals have mental health diagnoses. They all have mental health diagnoses. They have to have a mental health diagnosis to qualify for the treatment. But the question is how do you measure the quality of life because one of the things that this program does and many of the programs that people are speaking about today is it improves the quality of life and some of these things that are done, some of the various services that are provided, involve the relationship that is developed between the person who feels isolated, who feels withdrawn and feels disconnected and fragmented and improving their quality of life and all of us need that in order to feel life is worth living. It 119 5/12/03 - Health/Human Services - Resolution 030174 gives them hope and a feeling of belonging to something. So Vergi is only one person and she provides individual counseling, group sessions, outreach, case management, does all the various linkages, referrals, assessments, research, home visits among the few things that she does. It is difficult to replicate Vergi because she is only one person, but the funding, what we are doing here is a model program, and what I would like to suggest is for more of these kind of programs to be developed and to be recognized for what they offer throughout the city because of the quality that they provide.
Thank you very much. I guess I was going to ask -- my question was to Vergi about the need for additional staffing. I guess my question is -- and you just talked about the lack of funds and maybe the loss of this program, but if you did have the funding, is there personnel out there for you to recruit and hire to do the work from the Latino community and, if not, what is being done in the Latino community to encourage young people to go into psychiatric, social work or whatever the career track would be? 120 5/12/03 - Health/Human Services - Resolution 030174
I think that is probably a long-term issue in terms of ways to do more proactive recruitment, to provide education resources for minorities, for various subcultures, Latino, Asian, and I think that's something that will take a certain amount of effort, initiative across the board. I think what we are talking about is creating an infrastructure of some sort that has and provides coordinated care on every level, looking at staffing, looking at the quality of services that are being provided, funding resources, and I think what we have is a fragmented system that does not have a strong infrastructure where there is coordinated care, and I think what you are mentioning is one facet that is certainly a part of that.
If I may, Madam Chair, what about the community-based organizations such as APM and Congreso and Consilio who deal and have programs in terms of mental health; is there coordination with them?
Not with older adults. Most of those centers are stand-alone facilities 121 5/12/03 - Health/Human Services - Resolution 030174 where people have to go and walk in for services.
So what about the older adult centers that we have such as Norris Square and the Mann Center and so on?
I do provide services to various senior centers and one is Norris Square Center and Mann Adult Center and I'm there once a week and I do individual counseling and I do groups there and also at a church at the old Kensington pavilion, which is a housing project. Those services are provided there. And what happens sometimes is Congreso has referred all of their adult clients to us for mental health services.
Are there any other questions or comments? Our next panel will be Lois Semanision, Sandra Smith and Trudy Persky.
I have worked in Philadelphia as a social worker for the past 28 years. I just want to say I consider what I do a privilege. I really love working with poor people and trying to enhance their quality of life. Right now I am working at a number of different capacities, two of which are working part time with both Aid for Friends and the Family Life Wholeness 122 5/12/03 - Health/Human Services - Resolution 030174 Center which is a center operating out of a church in North Philadelphia at 11th and Nedro, and I volunteer in a center in South Philadelphia as well.
That's my district, 11th and Nedro. What's the center?
It's the Saints Tabernacle Community Church and they have the family center there and they are near the El stop, if that means anything to you. But those are a couple of the things I do. The people that I'm working with through Aid for Friends and the Family Life Wholeness Center are receiving a meal program that Aid for Friends provides. The one thing that is different about Aid for Friends that other meal programs like PCA, we don't -- there is no income requirements. There is no health insurance requirements. The requirement is that the person is isolated and homebound and either elderly or disabled. I think Aid for Friends is serving about 2000 people currently and my primary function is to do outreach to those who are mentally ill and I have worked with over 200 people since I have been working in this capacity, so that's a lot of people. 123 5/12/03 - Health/Human Services - Resolution 030174 The people that are served by Aid for Friends are all over Philadelphia but also some of the surrounding counties. In working with the homebound mentally ill, I have run into many challenges. I think some of these have been mentioned already. There is a limited number of resources available even to those that are not homebound and persons that are homebound, getting to the facilities that have been described are major challenges. I think the one lady who was sitting on this side talked about the difficulty of just providing transportation, getting there, accompanying the person to the visit, et cetera. What I found sometimes is agencies give numbers and say go here, go there, but not taking into account that may be a major hurdle for the person to get there. Aid for Friends in addition to myself, and I only work part time, they have a worker who is bilingual who works one day a week. She came in as an intern, a graduate intern for social work, and I supervised her and she has been working a day a week, but now she will be looking for other employment, so I'm not sure if they are going to be 124 5/12/03 - Health/Human Services - Resolution 030174 able to replace her or not. I'm really concerned when I work with the homebound and the elderly disabled. It seems that the majority seem to get their prescriptions from a general practitioner and one general practitioner said to one of my clients "I'm going to give you a happy pill" and didn't tell the client anything about the pill. She took it. She didn't feel it helped her. She had someone look up information on it and then she decided to stop taking it. I think that's a really poor way to handle her mental health situation and in her case it is depression. So she is not getting any help at all. Another example that I have, I have a lady whose doctor said "Take six of these a week," so she thought let me just take six on the first day of the week and get it over with and you can imagine what havoc that wreaked in her system. That same person had to be rushed to the hospital at a later time because they had a bleeding ulcer. Just the confusion about medications, et cetera. What would help me greatly because you have been asking people for suggestions, we at one 125 5/12/03 - Health/Human Services - Resolution 030174 time had a nurse intern and we had a volunteer nurse. If we could have the City make a nurse available from the health centers to go out to visit people, do an evaluation on the medication, just make sure that they are taking the medication as prescribed, you know, help them sort through the little pill bottles, educate them about their illness, things like that, when we had that available, it was very, very helpful, and I think that is something that the City could make available to agencies such as ours, a nurse that could go and do education and just checking on the medications, make sure the person understands what they are taking, also, write out questions. "When you go to the doctor, these are the questions you need to ask," that kind of thing.
I do that a limited amount, but that is not my area. I'm a social worker. I'm not a nurse, but I do look up medications for clients. " The doctor changed the medication and the nightmares went away. I mean that was an intervention that I think was very significant. If that hadn't been done, maybe the doctor would have given him something for anxiety or given him another medication to treat the symptom. One of the things that has already been mentioned, sometimes people are denied services because they don't fit into the category. I had a lady who was suffering from agoraphobia -- that is a person who is afraid to go out -- and she was told she was not eligible for the homebound service because they were not permitted to treat that diagnosis. She had to go into a center. The chances of her going into a center are pretty slim. She is having trouble getting out of her house. But the agency couldn't treat her because of their guidelines. What I have personally found most effective is where I work in faith-based organizations, but where -- and that is what I really feel is effective, where you can treat the whole person, where you can be comprehensive, you 127 5/12/03 - Health/Human Services - Resolution 030174 can be flexible. Everybody doesn't have to fit into all of these little categories. You let the client tell you or show you what they need rather than you try to get them to fit into this little category. And I understand funding constraints and all of that, but... The other thing that I have encountered that I really wanted to mention is in addition to the mental health issues are the substance abuse and gambling addictions and I know you are going to be looking at gambling in the city. Gambling addiction is a big problem with seniors. Please hear me on this. Let give me an example. A couple that I was working with, they needed help in getting a new heater and when I added up the amount of money that was being invested in that house, it was 5 to 6,000 a year. A new heater costs a portion of that. They didn't have money for a heater and they were bugging all the agencies to help with that. Fortunately some help was obtained, but gambling addiction is a big problem with seniors and I really have a problem with all the senior centers and senior programs, what kind of entertainment do they provide to the seniors? Bingo and trips to Atlantic City, not 128 5/12/03 - Health/Human Services - Resolution 030174 realizing these seniors don't have that extra money to spare. And gambling addiction is a problem in addition to substance abuse, misuse of medications and misuse of alcohol. The other thing I run into a lot is domestic violence by natural exploitation. You will have the adult children living in the household or siphoning off mom or grandmom's money and fortunately OESS and the Corporation for Aging both have services where they can intervene and take over management of the money. In one particular situation where the intervention took place, it is working real well. The child no longer has access to mom's money and they are getting along very well, but when he had access to mom's money, he was spending the bill 18 money all the time and that made mom anxious and depressed, et cetera, et cetera.
My son doesn't steal my money but I give it to him and I'm still depressed, just to add a lighter note. Children do that.
The other thing that seniors and the disabled that are homebound -- 129 5/12/03 - Health/Human Services - Resolution 030174
Yes. They are always running in crisis. The doctor is giving them bad news. Things are always happening. I find that just being that person that can give support, who can debrief, who can hopefully line up some other agencies, that role is really important. My role is not so narrow that I can't be flexible in addressing. The other thing, I don't hear you asking a whole lot about research and just you need to research the people who are receiving these services. I mean Penn, Temple, all of those schools do have research programs. They could easily do a research program with the recipients of these services and see what the problems are that the clients are encountering. You are hearing from the service providers, but I also hear from the clients and I think a research project would be worthwhile before you make a lot of decisions in terms of how you are going to expend City Council's money.
Good point. Thank you. 130 5/12/03 - Health/Human Services - Resolution 030174
My name is Sandra Smith. I'm an intensive case manager. I have worked as a care manager in Philadelphia for years. For the 5 first two years I did intake and community liaison. 6 I mention that because that is something, to quote 7 Estelle Richman, that is a thing of the past, and 8 that is something that I feel is very important 9 because when I was the community liaison, when a 10 phone call came, I could go to someone's home to do 11 an intake. As an intensive case manager, I work 12 primarily with the elder population, but that is 13 changing as budget changes. 14 I personally don't like to work with 15 people under 40. I'm being honest. I always say if they are born before 1940 I don't want to see them. I much prefer to work with the elderly population.
I'm sorry. After. You know, I much prefer to work with the elder population. 131 5/12/03 - Health/Human Services - Resolution 030174 But as an intensive case manager I won't say that I have seen it all because every day you see something new and I just wanted to share one story because the time is so short of some of the things that don't happen. As case managers we are told that we are supposed to link and monitor. Well, the difficulty with linking is tremendous. I heard a lot of comments here today and I was wondering because I have made calls to CBH and have not been able to get the services of the two companies that were mentioned. It is very difficult to get services. But I wanted to share this one story with you. There was a couple. They both experienced mental illness and they were receiving services. As they got older, their health deteriorated. It came to a point where the husband in the family became wheelchair bound and his weight increased so it was very difficult to get him to his psychiatric appointment. What happened, I arranged for the ambulance to take him to the psychiatrist's office. He had to be taken in on a gurney. It went well for a couple months. Then I was told by the therapist that we could no longer bring this 132 5/12/03 - Health/Human Services - Resolution 030174 gentleman here because we passed the geriatric program and it was too disturbing to the clients in the program to see someone coming in in a wheelchair. You have no visiting psychiatrists -- if there are, I haven't heard of them lately -- in Philadelphia. So this man lost his services because what we had to do was, at risk of Tom O'Hara where I work, there was actually a psychiatrist who went to this person's home to prescribe medication for him because there were so many really severe problems. And my problem is that, yes, they say you are a case manager. This population is served. Not true. The services are not there. We cannot link them to someone because there is nowhere to link. You know, they talk about all the entities working together. I can sit here and tell you at my level, myself, the PCA care manager, and the home health aides, we can work together. As a matter of fact, Trudy Persky can tell you. I managed to pull together a meeting -- there were seven of us in that meeting -- to address the issues of this same individual because the funding wasn't there to provide that service, but each person 133 5/12/03 - Health/Human Services - Resolution 030174 involved had a vested interest because the need was so great that we were able to provide this. I know, Miss Reynolds Brown, that this all came as a part of no services to West Philadelphia. I can tell you I was one of the people who was hired to work with Horizon House and then the program was cut by the City. So that's what took away the services in that part of Philadelphia and, believe me, I begged, but nothing worked, but the reality is we have people who have mental illness and have physical ailments who need services and we just can't get them for them. I can tell you this is what you get. You call PCA, they say that is a mental health issue. You call Mental Health and they say that is a PCA issue. Fortunately, I was able to get the two of them to like get some funding from one group and some from the other, but the reality is we do need coordination.
She's the best as a case manager. I can testify to that. 134 5/12/03 - Health/Human Services - Resolution 030174
I'm Trudy Persky, and, as you can see, I'm a senior citizen. No Botox. And I have been a mental health aging advocate for over 7 years and it has certainly made me age faster than I 8 would if I hadn't been doing this. 9 Now, the question that has troubled me 10 for a long time and I would like to move this not 11 totally out of Philadelphia, but to say that there 12 are broader issues that I think we in Philadelphia 13 also have to address. The question is why, why is 14 it so difficult for millions of people in this 15 country to get adequate mental healthcare? Because 16 we have data from all over the United States, and 17 while some cities may be progressing faster than 18 Philadelphia, the fact is that mental health 19 services are extremely limited. Older people don't 20 go and the services that are available are not responsive to their needs. So I would just like to list some of these major issues which are the media portrays older people in very undignified ways or they idealize them. And this comes from the Annenberg 135 5/12/03 - Health/Human Services - Resolution 030174 School of Communications, which states that when you look at TV, you either see older people that are on a cruise, they are on a golf course, or you see somebody in a wheelchair in a nursing home who seems incapable of even speaking one sentence. So people do not get an accurate picture of what it is like to be an older person. So this preoccupation with youth I think has really been very difficult for advocates because if people don't want to think about getting older, if people don't want to even -- the business with the living wills, it's going to really put enormous obstacles in the path of an advocate. Now, you have heard before there is a tendency of many physicians to dismiss any illness as aging. I have heard doctors say, well, what do you expect, she's old, when the person may be depressed, may be highly anxious, but this is a prevalent response from many physicians. Also, as mental health advocates we have not had a strong advocacy group. We have not had a group like the Alliance for the Mentally Ill or Alzheimer's Foundation that is going to really advocate for people with mental health problems, 136 5/12/03 - Health/Human Services - Resolution 030174 particularly for older people with mental health problems. I'm glad to say that we are in the process of forming a national organization now, but it is going to be a long time before we really have the kind of effectiveness that you see, say, from the Alliance for the Mentally Ill or AMI, as they are called. Older adults with physical or mental incapacities are certainly not going to be active advocates, so for the time being we have to depend on other groups. For the past decade funding of priorities on the federal, state and local level have been for, quote, seriously and persistently mentally ill and children. Now, despite the generous mental health state budget, I can tell you last year it was one billion eight hundred thousand dollars and the amount that was allocated for older new programs even came from a block grant from the Feds, not from the mental health state budget. So when you asked what can we do, I think certainly one thing that Council can do is bring pressure on the state that considering the population here, the numbers, that we have to have more money if we are going to 137 5/12/03 - Health/Human Services - Resolution 030174 provide any adequate services. You have heard before the reimbursement, Medicare reimbursement, it is absolutely a mess. I mean economists agree there is no worse system than the Medicaid reimbursement for mental health. Only a total of 3 percent of the Medicare budget, which is an enormous budget, goes for mental health and that is primarily for people in hospitals. I think that also the mental health programs have to be more responsive.
It is true we have data showing that older people will not go to mental health centers and so we have to have more outreach programs to identify people with mental disorders. Now, I think what can we do? Here are some recommendations and I would urge the Council to consider what you can do. Urge the state Office of Mental Health, as I said, to include older people as a priority population. For years I was on the mental health planning council for the State of Pennsylvania. " and they say, "No. We have these priorities. We have to adhere to those priorities," and when I talk to 138 5/12/03 - Health/Human Services - Resolution 030174 the federal government they say, "No, you really don't have to but they are the priorities of the federal, state and local government," and when you hear, as Sandra said, there are people that don't get services, it is because they don't fit into particular classifications for the seriously and persistently mentally ill and they are certainly not children. So I hope you will give that careful consideration. Another problem with the mental health and aging process is that we don't have adequate people. There are not enough trained people and these budget cuts have resulted in many people losing their jobs and not being able to provide adequate services. We have heard -- I don't want to repeat this -- that mobile programs are very effective and we certainly have data that that is true. I think too that I will say this, the federal government is developing programs, trying to have programs for primary care physicians so that they will better understand the issues of older people, and we did have such a program here in Philadelphia for four years. There was a program at 139 5/12/03 - Health/Human Services - Resolution 030174 the University of Pennsylvania which permitted people to have mental healthcare when they were getting their primary medical care. It worked out very well. People were much more responsive. If this is an issue of your general health, they will be much more responsive to accepting mental healthcare. So I also would like to say this: There has to be some strong encouragement for better collaboration at the state level of Mental Health and Aging. This is something that has been -- we tried for years, but it has been extremely difficult to get these two organizations together and to develop plans that are interactive. Now we have two new people in those positions and maybe that will make a change. I certainly hope so. The other thing I wanted to say that I think we have lacked is a public educational campaign which really helps people to be more aware, to stimulate awareness about the issues of older people. We haven't had a general educational campaign and one reason is it is very difficult to get funding for that. I would just like to close with this one 140 5/12/03 - Health/Human Services - Resolution 030174 thought, that we should keep in mind that we have very good data that the treatment of older people suffering from depression and anxiety and other diagnostic problems has been found to be just as effective as with young adults and middle-aged people. Supportive therapy with drug treatment can be safely administered with very beneficial results.
Thank you very much. Any questions or comments from members of the Council? (Applause.)
Thank you very much. We next have Almena Tugman, Rose Bradley. Are they here? Dr. Bloom? He's not here.
Good afternoon. My name is Almena Morgan Tugman. I'm nervous today. I'm going to let Debbie Huff read it for me.
No, you talk for yourself. Tell me what you wanted to tell me. Tell us what you wanted to tell us.
Hi. I'm Debbie Huff. I'm the advanced practice nurse that does the health 141 5/12/03 - Health/Human Services - Resolution 030174 district center project and Almena is one of my consumers and she is extremely nervous today, so she asked me to read her testimony. We are thankful that she is here.
"My name is Almena Morgan. I am a patient of the Health Center No. 4. On December 5, 2001 I lost my grandson. He was strangled at 3 years old. I was helpless. I went to the clinic and my doctor advised me to seek professional help. On the same day I was able to see Miss Huff. I was really depressed. I could not eat. I could not sleep. The only thing I was capable of doing was crying day and night. I eventually went to see Dr. Curlik, the geriatric psychiatrist of the program, who assisted me in coping with my depression. I am still receiving help from the center. "Mental health affects thousands of people each year. Some lose jobs. Some lose a friend or a relative to death. Some are sick and some are retired. Lives are lost each day due to some aspect of mental illness. Suicide is the most 142 5/12/03 - Health/Human Services - Resolution 030174 frequent method used to escape depression. If these individuals were treated and shown ways to cope with the uncertainties of life, they would be here today. There are also those who are ignorant to the different forms of mental illness and don't know that help is available. "The weather is getting warmer outside and summer is almost here. After being in the house all winter older adults would love to get outside and enjoy the sunshine but are afraid to do so. They lock themselves up in their houses and apartments, often locking windows and doors, also stopping airflow. Some die. This happens because they are afraid to come out of their homes. Sometimes all that is needed is a friendly face with a smile or a gentle touch or maybe a hug or just someone to say I love you. Where can they go for help? Fear can bring on panic attacks. It also leads to mental illness which can affect every part of life. We need to find a way to open the doors and assist those in need. "The Health Center has so many life management programs available, all within the same location. We need more funding to improve and save 143 5/12/03 - Health/Human Services - Resolution 030174 the lives of our older adults. We may need to spread the good news that older adults have an avenue to assist them in the many complexities of life and I am grateful for Miss Huff's program and I'm glad they were there to help me."
Thank you very much for the testimony. We are very sorry about your grandson.
My name is Rose Bradley and I'm a senior citizen myself. I have two elderly people that I take care of. One is 101 and the other one is 100, okay, and they sent me a counselor to help me because I have a lot of anger in me. I really did. And I have come here to thank her today for what she has done for me. That is what I came to do. And I want to thank her for her support that she has given me and I also want to thank you for understanding that. She gave me things I could control and things that I can't control and I wanted to give her thanks for the support that she gave me 144 5/12/03 - Health/Human Services - Resolution 030174 in dealing with my family and my kids and I also want to thank the Intercommunity Action Corporation for sending her to me, and I thank you all, too, for hearing me.
The elderly people you are keeping, are they family members?
No, my mother-in-law, I put her in a home, but I still have my mother. I had my mother-in-law for seven years and I have had my mother for four.
I can understand that can be quite a responsibility and we thank you so much for coming down to thank those people who provided supportive services to you.
And thank you for 145 5/12/03 - Health/Human Services - Resolution 030174 staying so long. You have been here the entire time, all of you have, and we really appreciate it, but once we get into the discussion, it becomes very long. It doesn't look long on paper, but when we begin these hearings, we can get kind of lengthy, so we thank you so much for your testimony, both of you.
We have Eun Sook Kang, Jennifer Romanski and David Downey. These three members are the last panel members unless we have other people to testify. You let us know.
While we are waiting for the other panelists to be seated, it is really the testimony of the last two ladies that we heard, Rose Bradley and Almena Tugman, that really underscore and reaffirm the reason. The question is give me a reason. The testimony of the last two individuals certainly compels us to, as the chairwoman has said, leave this open because there is much work that will be required in the followup to these hearings.
Thank you very 146 5/12/03 - Health/Human Services - Resolution 030174 much. Would you like to identify yourself for the record please and begin your testimony?
Yes. Good afternoon. My name is Eun Sook Kang and I am currently director of development at the Phillip Jaisohn Center, a Korean medical center and a community medical center under one roof. It has been in Philadelphia since 1975 and I wanted to say a brief commentary on Asian American adults and particularly those in Philadelphia County. I concur with all of the researchers and facts and data regarding the older adults and the population that they take up. The population of Asian American older adults in Philadelphia are comparable to that of the mainstream older adults. Asian Americans make up nearly 70,000 in Philadelphia County and in the past ten years between 1990 and the year 2000 there has been a nearly 78 percent increase in the number of Asian Americans. However, though we have much data and information on mainstreaming older adults and the fact that so much need exists and very little of 147 5/12/03 - Health/Human Services - Resolution 030174 that need is being addressed and met, with Asian American older adults there is no research data on the numbers of seniors who need mental health services or seniors who may be suffering from depression, schizophrenia and other psychiatric disorders or emotional disorders. So with that Asian Americans, even though they only take up about 4 percent of the total population here in Philadelphia, there is a need and the numbers of Asian Americans are growing. The percentages of Asian American seniors is comparable to that of the percentage of seniors here in Philadelphia County in the mainstream. Out of that 70,000 Asian Americans nearly percent of that are made up by Asian 17 American seniors, and what I propose is even though 18 there is no data, I belong to a coalition within PCA 19 called the subcommittee on mental health on Asian 20 Americans. The committee is PCA Asian advisory 21 committee subcommittee on mental health. So we just 22 began to form some working data on how to do any 23 needs assessment on Asian American seniors in Philadelphia County because all the social workers and different social service agencies obviously see 148 5/12/03 - Health/Human Services - Resolution 030174 a need. We can't prove the need because there is no 3 data because we keep going around in circles. We need to begin to do some sort of hard work as a coalition, doing some coordinated comprehensive work in Philadelphia to address not only the mainstream need, but we are trying to do some work together as a coalition to at least conduct some kind of needs assessment by a social services agency so at least we can get a small amount of data and prove so we can get funding to address the needs of Asian American older adults here in Philadelphia. And as just a social worker and case manager at the Phillip Jaisohn Center, I just on a daily basis see and hear many Asian American/Korean American older adults who have gone from the extended family where the children are the social security, to second generation Korean American or other Asian American older adults. They go from living in the extended family situation where the kids and the grandkids take care of their mother to now more and more you see a prevalence of these older Asian Americans moving into Section 8 housing or moving away from their kids' homes and living by themselves because they are bored, and more and more 149 5/12/03 - Health/Human Services - Resolution 030174 there is a need for the formalized support network, and their access is quite limited because of the language and culture and that is why these ethnic organizations such as Congreso, Nueves Braze, Jaisohn Center and maybe Mexicanas back in South Philly are all very pivotal and crucial as well as the churches in meeting those needs and identifying at the grass roots level people in the community who they know very well by working daily. Even though we don't have data, we know there is a need, but there is no research and there is no money and so here we are.
I only represent 4 percent of the Asian population, but I see how I'm just a little tiny speck in this huge -- it is going to take us a while and we are going to just keep plugging away and trying to get any money, any resources possible, to try to at least address the huge growing need. I think even 1990 to 2000 there was an increase of 78 percent in the Asian Americans in Philadelphia County. We are going to see a higher, same, consistent comparable increase between 2000 and 2010 and the number of 70,000 Asian Americans is going to increase, possibly double even more, and 23 percent of them are seniors and we have no data and 150 5/12/03 - Health/Human Services - Resolution 030174 no resources to assist them, particularly the growing number of seniors. That's all I have to say. Thank you. )
Thank you very much and thank you for coming. Your center is in my district.
Good afternoon. My name is David Downey and I'm with the Visiting Nurse Association of Philadelphia and I think I'm in maybe a unique position here because we actually do provide psychiatric home care services to homebound Medicare patients, so we are in a position to seek reimbursement from Medicare and from the Medicare HMOs. However, having said that, we do run into a fair deal of difficulty because we see the patients probably in the very acute stage of their psychiatric illness, and where we run into difficulty is getting the services when the acute stage of the illness has passed where we are ready to move them back into the community, back into the community centers and what have you. That's where we run into problems. 151 5/12/03 - Health/Human Services - Resolution 030174 So I guess you have had all the statistics and the percent and the growing 4 population in Philadelphia. I think overall what we 5 really would need to do -- and people talked about 6 the turf wars -- is stop the turf wars, pull 7 everybody together and get all the services that are 8 available. I don't believe I'm the only agency that 9 can bill for the home part status of the Medicare 10 patients, but we do need some kind of coordination 11 of all the services where we can put all of those 12 mental health services together and talk to each 13 other for the interest of the older adults with 14 mental health problems. 15 I have heard all the other testimony, 16 but I think I don't want to be the person who 17 summarizes it all up, but from what I have heard 18 today I think that's what we need to do.
And I would like to thank you for that opportunity to say that and thank you again.
Thank you very much. We are very familiar with the Visiting Nurses Association way back in my early days. 152 5/12/03 - Health/Human Services - Resolution 030174
United Way committee that monitored the visiting nurses. Are your nurses psychiatric nurses?
My team of nurses are all psychiatric nurse providers. I have a team of ten nurses. We are not geographically limited in the city. We provide psychiatric services to homebound clients all over the city, north, south, east, west.
How does someone contact you? Are you contacted by social workers in a facility or family?
Various agencies. We have an active outreach program that will identify homebound elders. We have a program with the block captains and they will identify homebound patients. We get referrals from hospitals, primary physicians, so various and sundry agencies will refer to us to go and see the client in their home.
Thank you. Are there any questions or comments? Is there anyone else here to testify here today? 153 5/12/03 - Health/Human Services - Resolution 030174 We will have closing remarks from Councilwoman Brown.
I will certainly be brief. I want to thank everyone who, like us, saw fit to, A, be here and, B, recognize the importance of today's hearings. The record should show that this was not a solo act. I would be remiss not to thank my own staff, David Ford, who worked hand in glove with both Corbett Banks and Tom Volkert. So thank all of you. The record should also reflect that this is Chapter One. There are still many more chapters that have to be written in terms of a hard document that we are anticipating and then recommendations that will be crafted and sent to the administration, so know that. We are going to have to work together collaboratively and not just talk about it, but be about it when it comes to addressing this issue of linkage and the like. Thank you all very, very much. (Applause.)
Thank you all for coming. We appreciate it. We thank the observers who came to listen. We will recess this committee 154 5/12/03 - Health/Human Services - Resolution 030174 until the call of the Chair. Thank you. (The hearing ended at 1:50 p.m.) 155 CERTIFICATE I HEREBY CERTIFY that the foregoing proceedings of the Committee on Public Health and Human Services of the Council of the City of Philadelphia of May 12, 2003 were reported fully and accurately by me and that this is a correct transcript of same. ______________________________ Cynthia A. Whyte, RPR (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)