Susan Olin— a single, 58-year-old Caucasian woman— became homeless at age 40. Currently living illegally in the living room of a man who actively uses substances, she spends much of her time on the streets. One daughter and both siblings died of overdoses; her mother and other daughter have disowned her. She has been accepted into a methadone outpatient program, receives psychotherapy, case management, medical treatments and SSI. She received a Section 8 voucher, but missed her appointments. Subsequently the voucher expired and cannot be renewed. Wait lists for public housing are too long, and a history of arrests may prejudice her application. She could enter a transitional housing program but the programs only take admissions from city shelters. She feels worn out, tired, and sad about not having her own living space at this stage of her life.
Addresses the intersection among poverty, homelessness, aging, and substance abuse; fragmentation of services; housing policies that serve as a barriers; priority given to shelter residents to the detriment of those coming from equally impermanent community settings; and policies allowing job training/opportunities for older adults, especially those policies to support a range of treatment approaches to substance abuse in older adults.
Classroom Activities and Assignments
Include analysis and research of the Geriatric Chemical Dependence Act of New York State; debate on maintaining substance abuse services; identification of internet policy advocacy organizations in alcoholism and substance abuse; determining policy positions on the needs of older adults with alcohol or substance abuse problems; preparation of a 5-minute oral testimony to a mock legislative hearing; preparation of testimony to a mock legislative hearing in support of the Geriatric Chemical Dependence Act; preparing testimony; position papers of advocates and consultation with practitioners in the field; investigation of Medicare coverage for substance abuse services;an eco-map including policies or programs; research evidence for effectiveness of prevention programs for youth making inferences as to the human and financial cost savings over the last 40 years to client and to the tax-paying public if client had received prevention services as a teenager; and development of an advocacy agenda to counteract proposed cuts to substance abuse services, especially services for older adults.
Competencies for Susan Olin Case Study:
- Understand and direct the ways one’s own values and biases regarding aging impact professional practice and ethical work with older persons with substance abuse/misuse concerns, their families, and the provision of aging health and mental health services.
- Develop strategies to change policies, regulations, and programs to improve the well-being of older persons with substance abuse/misuse concerns and their caregivers, particularly historically underserved groups.
- Identify ways to ascertain the health status and physical functioning (e.g., ADLs and IADLs) of the older person with substance abuse/misuse concerns in order to provide assistance.
- Assure appropriate access, utilization, continuity, coordination, and monitoring of the continuum of public resources for older persons with substance abuse/misuse concerns including community-based care, residential care, nursing home, and health/mental health services.
- Assess and address impacts of social and health care policies on practice with historically disadvantaged populations.
- Develop strategies to address service gaps, fragmentation, discrimination, and barriers that impact older persons with substance abuse/misuse concerns, including intergenerational approaches.
- Adapt organizational policies, procedures, and resources to facilitate the provision of services to diverse older persons with substance abuse/misuse concerns and their family caregivers. (a) Contribute to the development of policies covering work site inspections and safety regulations that would apply to special needs of elderly such as special provisions made for the handicapped. (b) Advocate for the development of new roles and new options in work settings for elders, such as specialist, consultant, part-time work, and flexibility in hours.
- Be able to identify, locate, and appraise quality of empirical evidence supporting assessment and intervention in older persons with substance abuse/misuse problems.