HOW DOES DELIVERY OF PSYCHOLOGICAL SERVICES TO OLDER PEOPLE DIFFER ACCORDING TO THE SETTING WHERE THE OLDER PERSON RECEIVES THEM?
American Psychological Association
Table of Contents
Why Practitioners Need Information
Psychological services may be provided to older adults in a wide range
of locations including in their own homes; outpatient and inpatient medical,
rehabilitative, or psychiatric settings; adult homes (also referred to as
board-and-care facilities); senior centers; day care centers; and nursing
homes. For some settings, specific issues must be addressed when delivering
services.
- Psychologists who see older clients within an independent practice or outpatient mental health settings need to be flexible about missed or rescheduled appointments. This is required because of acute medical crises, responsibility for care of infirm relatives, or the understandable reluctance of many older people to travel during inclement weather.
- Close and timely coordination with other professionals is particularly important when providing psychological treatment to older people in inpatient medical, rehabilitation, or psychiatric settings where increasingly there are abbreviated lengths of stay.
- There has been a significant increase in the delivery of mental health services by psychologists in nursing homes. Nursing home clients perhaps present the greatest challenges for psychologists of all older adults seeking psychological services.
- Usually nursing home clients are physically frail and have cognitive deficits. This requires the psychologist to be especially flexible and creative about adapting psychological interventions so that they are most useful to the client.
- Because psychologists sometimes work for nursing homes or depend on the cooperation of their administrators to deliver services there, sometimes they are pressured to act in ways that may not always be in the older client's best interests (e.g., silence an angry and complaining older client who may have legitimate concerns about the quality of care that is being received). Maintaining clarity that the client's interests are foremost is consistent with ethical principles.
- Privacy of psychotherapeutic sessions may require considerable effort, because older residents often have roommates, and finding a quiet, separate place to talk may be difficult. The psychologist must make certain that the client consents to sharing the contents of any psychotherapeutic session with other staff.
- Since the nursing home is indeed the older client's home, environmental and interpersonal issues may have an important influence on the client's emotional well-being. Interventions made on behalf of the client are sometimes necessarily those that seek to change institutional routines, reduce environmental stresses, and decrease maladaptive behavior on the part of staff toward the patient. In view of these issues, collaboration and coordination with nursing home staff are critical. (See Standards for Psychological Services in Long-Term Care Facilities for a more detailed account of these issues.)
