On some days, the 78-year-old nursing home resident succumbed to the confusion of early Alzheimer's disease. On other days, her lucidity returned. That's when she begged the staff to call her son and have him move her across the country to be closer to her family. The nursing home staff ignored her requests, dismissing them as the ravings of a demented old woman.

"If I hadn't intervened, the woman would still be at that nursing home completely separated from her family," says psychologist William Myers, PhD, who helped reunite the woman with her family as part of his work consulting with nursing homes in York, Pa. "Without staff trained in mental health, the quality of life for these older folks is tragically and unnecessarily diminished."

To help prevent such scenarios, Myers and other psychologists have been working to persuade legislators to include mental health training provisions in bills that would reauthorize the Older Americans Act (OAA) for another five years. Designed to ease a severe shortage of psychologists and other mental health professionals trained in gerontology, the provisions authorize federal funds to be spent on graduate and postdoctoral education.

If passed, the OAA legislation will authorize Congress to fund up to $1.44 billion in health, employment and lifestyle programs for older people this year. Although unrelated negotiations stalled the bills last fall, APA is hoping Congress will make reauthorization a priority in the second session of the 106th Congress.

One-on-one advocacy

APA has already enjoyed a number of OAA-related successes that could help the ever-increasing number of older Americans, according to Nina Levitt, EdD, director for education policy in APA's Public Policy Office.

Thanks to APA's advocacy, the House and Senate reauthorization bills (H.R. 782 and S. 1536) contain first-time-ever language that would provide doctoral and postdoctoral training to psychologists and other mental health professionals interested in working with older people both in institutions and the community. In addition to this training provision, the House bill also expands funding opportunities for psychology by adding the words "mental health" to places where health is mentioned.

"The House really took off by including mental health in a number of areas," says Levitt. "And since the Senate really didn't want to make major changes in the legislation, getting the education and training provision in was a significant accomplishment."

Assistance from APA members helped APA's staff win these victories, says Levitt. Myers, for instance, met with Rep. William F. Goodling (R-Pa.), chair of the House Committee on Education and the Workforce. He told the congressman and his staff that nursing homes and similar facilities typically lack staff with the training to cope with residents' mental health problems. Most can't even distinguish among dementia, depression and adjustment disorder with depressed mood, says Myers, noting that these conditions are extremely common among nursing home residents.

Lynne A. Steinman, PhD, a private practitioner in Santa Clarita, Calif., already knows how valuable training in gerontology can be. In a meeting with Rep. Howard "Buck" McKeon (R-Calif.), chair of the Postsecondary Education, Training and Lifelong Learning Subcommittee, she explained how her dual degree in clinical psychology and gerontology has helped her provide much-needed services in the congressman's district. Steinman helped train the staff of a day treatment facility for older adults with dementia and other illnesses, for example.

"I taught them how to deal with the difficult behavior of some dementia patients, so that they wouldn't take it personally if somebody asks them the same question four times," she explains. "Once they're able to interpret behaviors correctly, they're able to provide care that's a lot more constructive."

Of course, not all geropsychologists specialize in clients suffering from dementia. Paula E. Hartman-Stein, PhD, a consultant at the Center for Healthy Aging in Akron, Ohio, shared her experiences working with relatively healthy older people and their families in a meeting with Sen. Mike DeWine (R-Ohio), chair of the Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee.

Although Hartman-Stein also performs neurological assessments and guardianship evaluations, the bulk of her work consists of providing psychotherapy to older people and their families. Group therapy, which allows older people to overcome isolation and share solutions to common problems like illness and relationships with adult children, is especially effective, she told Sen. DeWine.

Hartman-Stein's first visit to Capitol Hill was an eye-opening experience. She says, "The trip made me understand much better how an individual psychologist can actually make a difference."

Rebecca A. Clay is a writer in Washington, D.C.