When the Therapist Comes to You: A Model Home Visiting Program for Seniors

Sarah is 95 years old and is determined to live out her days in the small New York City apartment she has called home for over 60 years. Her walls are covered with four generations of family photographs, and her shelves are filled with books and mementos of her work as a teacher and travels with her husband and family.

Sarah is able to remain in her home thanks to a network of formal and informal services available in New York City, including caregivers, neighborhood shops that deliver groceries, a friendly visiting program through her synagogue, assistance from her building staff, and daily calls and visits from her adult children who live nearby. She had considered a move to a nursing home, but that she has found a way to age in place successfully with the support of her family and other resources.

In nice weather Sarah goes out in her wheelchair, but there is one place she never goes: the doctor’s office. Six years ago, her physician encouraged her to enroll in Mount Sinai Visiting Doctors, a home-based program that makes over 6,000 medical visits to homebound New Yorkers each year. Sarah receives all of her medical care at home—and she hopes that she never sees the inside of a medical office or hospital again. She appreciates and enjoys the visits from the nurse, doctor or social worker, which often brighten up a long day.

Last winter, when Sarah became anxious and increasingly impatient with her caregivers, her Mount Sinai social worker referred her to Service Program for Older People (SPOP), a behavioral health agency for adults age 55 and older, which works in partnership with the Mount Sinai team. Sarah enrolled for behavioral health treatment and now receives weekly visits from her therapist that focus on mindfulness, relaxation techniques and strategies to manage her relationships.

SPOP is the region’s only agency that is exclusively dedicated to meeting the behavioral health needs of older adults. The agency operates a clinic, which serves over 600 adults each year, as well as free Bereavement Support, Training & Education, Information and Referral services, and New York State’s only all-geriatric PROS/Personalized Recovery Oriented Services program for those with severe mental illness. SPOP has provided home visits for 45 years and has demonstrated that the home visit is effective in improving the emotional well-being and overall health of the client – while alleviating social isolation and providing some respite for caregivers. About one-third of all SPOP clinic appointments are conducted in the home, and we are the region’s leading provider of in-home geriatric behavioral health care.

The partnership between SPOP and Mount Sinai Visiting Doctors addresses the comprehensive health needs of some of New York City’s most frail and vulnerable seniors. In virtually any other setting, this patient population would require nursing home care. The partnership enables seniors to age in place, reduces demand on the health care system, and has also shown that even the most fragile patients are able to benefit from behavioral health services and obtain a better quality of life.

We are proud to partner with the Mount Sinai team to support older New Yorkers like Sarah in their wish to age in place, and are especially grateful to our project funders, the Altman Foundation and New York Community Trust. Our partnership has provided therapy to over 80 homebound seniors since its launch 18 months ago, and Mount Sinai Hospital has become a leading source of referrals for the SPOP clinic.

The SPOP therapist and the Mount Sinai Hospital medical team are working together to make certain that Sarah receives coordinated medical and behavioral health care at home. She reports that she is now more comfortable and has gained the tools to manage her anxiety and relationships. With the support of SPOP and Mount Sinai, Sarah is on track to achieve her goal of never entering a medical office or hospital again.

Nancy Harvey, LMWS, has served as the chief executive of Service Program for Older People for 26 years. To learn more about home visiting and SPOP’s other community-based behavioral health programs for older adults visit www.spop.org or contact Nancy at nharvey@spop.org.

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