Catholic Health World

Program reaches out to seniors suffering with addiction

St. Cloud Hospital's program leads seniors to sobriety

By JUDITH VANDEWATER

ST. CLOUD, Minn. — The walkers that some elderly clients rely on for balance scuff the linoleum hallways at Recovery Plus Addiction and Mental Health Services. The marks are a reminder that it is never too late to develop — or recover from — addiction.

Addiction researchers believe that seniors are the least likely demographic group to seek treatment for alcohol or other chemical dependencies. But when they do, said Sandy Manderfeld, a Recovery Plus staffer, seniors are somewhat more likely than younger patients to be successful at maintaining their sobriety.

"Although the elderly are still at high risk for relapse, they tend to go longer between slips than younger people who have undergone treatment for chemical addiction," Manderfeld said. She speculates the reason may be that when seniors get sober, they feel markedly better. "Their quality of life is better, and they like that."

Family members who had kept the active alcoholic at a distance may start to visit or call more frequently. "People may say, 'I can talk to my grandchildren again.'"

Identifying seniors with alcohol and other drug addictions and getting them into treatment is a continuing challenge that requires networking and outreach, Manderfeld said. It falls to Senior Helping Hands, a program coordinated by Manderfeld, to educate people about late-life addiction and resources available to combat it. Senior Helping Hands is part of Recovery Plus, a chemical dependency outpatient treatment program run by the behavioral health center at St. Cloud Hospital.

Senior Helping Hands was launched 25 years ago this spring after a community task force determined that seniors with chemical dependencies and mental health issues were being seriously underserved.

If health professionals were to rectify that, they would have to break through the isolation that often accompanies addiction, depression and anxiety in seniors. Addiction, particularly addiction that develops late in life, is often hidden from public view. To reach those in need, health providers would have to raise community awareness and find partners in family members and other individuals who have personal relationships with seniors in trouble. "It all starts with awareness," Manderfeld said.

Raising awareness
To raise awareness, Manderfeld and other members of the Senior Helping Hands professional staff speak to community groups, clergy and health professionals on the subject of late-life addiction. They teach family members how to recognize addiction and stage interventions to convince an addict it is time to get help. And they advise individuals on how to make the financial and insurance coverage assessments that will impact how they access care.

A Recovery Plus staff member visits elderly patients hospitalized at St. Cloud following falls when there is a suspicion that drugs or alcohol may have been a factor.

Senior Helping Hands services are offered at no cost. The program is supported by grants from the United Way, the CentraCare Health Foundation and other organizations. It serves 14 counties in central Minnesota, reaching seniors who might otherwise go untreated for addiction or unsupported as they wrestle with mental health issues.

That's a tall order and a wide territory. Senior Helping Hands has multiplied its reach and effectiveness by building a large stable of volunteers. The volunteers mentor patients receiving addiction treatment at Recovery Plus. They drive patients to support meetings including a continuing care program for older adults at Recovery Plus and a weekly Alcoholics Anonymous meeting in St. Cloud that caters to seniors.

In addition to the 50 Senior Helping Hands volunteers who assist people recovering from chemical dependency, the 100 volunteers in Senior Helping Hands' Elder Network help older adults struggling with emotional distress or mental health issues in their homes. They offer companionship and an attentive ear to the lonely, the depressed and the grieving.

Senior-specific therapy
Recovery Plus treats adult addicts of all ages, but seniors who enter its treatment regimen are segregated in therapy groups for older adults.

"All the treatment literature supports that move," said Nancy Fandel, an outreach case manager at Recovery Plus. "The outcomes are much more positive."

Seniors are more likely to attend support groups with their peers than they are a mixed-age group because the conversation is more relevant to their situations and experiences, said Bob Emerson, a devoted Senior Helping Hands peer volunteer. Emerson, who died in December at age 58, was a recovering alcoholic and former probation officer who had been an addiction counselor. In an interview last summer, he said seniors can't relate to the lifestyles or vocabularies of young addicts, and they can find both off-putting.

JoAnne Elwell, a Senior Helping Hands peer volunteer, said she is not sure she could have completed her treatment for alcoholism had it not been for the senior program. "It's very difficult to be around young people who don't really care" about the life experiences of seniors in recovery, she said.

Over the years, Recovery Plus' commitment to senior-specific treatment has waxed and waned. About seven years ago, it recommitted to it. Although research has shown that seniors have better experiences and outcomes in age-targeted chemical dependency recovery programs, it is sometimes difficult to have enough seniors in treatment at once to make peer segregation practical. That's one reason the model has not become the standard of treatment in recovery programs, Fandel said.

She added that the senior program at Recovery Plus has a well established reputation and a steady stream of enrollees.

Manderfeld said that being eligible for Medicare reimbursement enables Recovery Plus to offer the senior program. Recovery Plus qualifies for the reimbursement because it is affiliated with a Medicare-approved hospital. Most private alcoholism recovery centers cannot bill Medicare, she said.

In any given week, about 16 seniors undergo intensive treatment at Recovery Plus. Patients can stay at home if that environment is supportive and does not trigger a return to drinking or using other drugs. Most stay in supervised residences run by Recovery Plus. The length of the primary treatment varies by patient, but it is generally 28 days, sometimes longer. "We don't want to send people home too early. We've had insurers say, 'We only want people there for 21 days,' but it sometimes takes that long before their head clears," Manderfeld said.

Last year, 189 seniors entered addiction treatment at Recovery Plus. The number includes 105 men and 84 women, although some individuals are counted more than once if they relapsed and returned for additional treatment. Some of the "seniors" are younger than 55. Those individuals were better suited to the seniors' slower program pace.

Manderfeld said three out of four chemically dependent seniors undergo simultaneous treatment at Recovery Plus for addiction and co-occurring mental health issues.

Historically, people with chronic, lifelong addiction have accounted for two of every three senior patients, while one out of three patients developed their addictions late in life. But that ratio has changed, Manderfeld said, and people whose addictions developed late in life now take up close to half the senior slots in the Recovery Plus program. "We are seeing many more seniors who are reactive drinkers," whose problem drinking is triggered by a loss of a job, a spouse or a home, or the stresses and pain associated with aging, she said.

Another growing population entering chemical dependency rehab are seniors who have stopped drinking; but, because of medical conditions, may have started taking pain medications and developed a dependency.

Seniors respond to respect
Manderfeld said St. Cloud's core values of respect and protecting the dignity of the individual are essential to the care of chemically dependent seniors. Respect opens the door to trust, and trust is critical to a successful therapeutic relationship.

Patients report on satisfaction surveys that Recovery Plus staff listened to them and acknowledged their personhood. "That is what we really strive to do," Manderfeld said. Senior Helping Hands staff and volunteers stay connected after a patient's release. "We try to keep them involved and in recovery for the rest of their lives," Manderfeld said.

Copyright © 2010 by the Catholic Health Association of the United States
For reprint permission, contact Donna Troy or call (314) 253-3450.