In the context of recent national research findings that people with serious mental illness have a significantly shorter lifespan than the general population, the mental health community has directed much attention to addressing this disparity. Integrating mental health and health care has become an important theme of our work as we recognize the necessity to address the complex and comprehensive needs of our clients.
Several models have emerged to address this challenge, including: partnering/co-location of mental health and primary care services, the establishment of primary care programs by mental health agencies, and linkages with outside hospital – or community-based primary care providers. However, little attention has been focused on the housing needs of older persons who have serious mental illness with co-occurring serious medical conditions. This article describes one such model developed by The Bridge, a New York City-based non-profit mental health rehabilitation agency that provides services to 1,800 men and women annually.
Sheridan Hill House, located in The Bronx, is a newly constructed permanent housing building consisting of 24 studio apartments with community space and staff offices. Capital funding to develop the building was provided by the U.S. Department of Housing and Urban Development (HUD), New York State Homeless Housing Assistance Program, NYC Department of Housing Preservation and Development, and the Federal Home Loan Bank of New York. Ongoing operating and services funding is provided by HUD, the NYS Office of Mental Health, NYC Department of Homeless Services, and a special geriatric mental health grant from the NYC Council.
Each of the 24 residents, who are single adults who have serious mental illness and are medically frail due to age and illness, lives in a conventional studio apartment. The program has 24-hour staffing to meet the special needs of the residents. In addition to case management and medication monitoring, the program includes an on-site nursing component and an established linkage with a home care providing agency.
Nursing services at Sheridan Hill House are provided by a part-time Bridge nurse care manager and a nurse practitioner contracted through the Lifecare System of the Jewish Home and Hospital (which also provides the home care services). In addition to providing basic primary care services, the nurses provide staff and resident education, monitor treatment adherence and serve a vital function in communicating with outside medical providers to coordinate and integrate care.
The age range of residents at Sheridan Hill House is 58 to 81 years old; the median age is 63. Fourteen residents are diagnosed with schizophrenia, four with schizoaffective disorder, six with bi-polar or unipolar depressive disorder. Twenty of the 24 residents have hypertension, 17 have hyperlipidemia, nine have COPD, six have insulin-dependent diabetes, six non-insulin dependent diabetes, three have serious stroke histories, five have cancer histories (three receiving active treatment), two have Hepatitis C, three have neuropathy, two are legally blind, and six are wheelchair bound.
Funded for services by the NYS OMH as an SP-SRO with supplemental funding from the NYC Department of Homeless Services, regular staffing includes a Residence Director, round-the-clock residence counselor staff, part-time cook (a nutritious dinner meal is served daily), part-time peer worker, and weekend geriatric recreational specialist. Interns from the Bronx High School for Medical Science also participate in the program. Nursing staff is funded through the geriatric mental health initiative of the NYC Council.
The outcomes of the program have been truly gratifying. As a cost-containment model, the program has documented a sharp decrease in the number of emergency room visits and inpatient hospitalizations by residents. The rate of missed medical appointments is now close to zero and there is a very high rate of medication and treatment compliance. Many residents whose health was previously highly unstable have been maintained in the residence without significant medical emergencies.
Housing for older people with serious mental illness will become an even greater need and challenge as the mental health population ages and as the recent adult home relocation order is implemented. The Sheridan Hill House model is appropriate for those who have serious medical conditions but who, with appropriate supports and services that an enriched congregate care setting can provide, are able to remain in the community to protect their quality of life and avoid costly nursing homes. As such, Sheridan Hill House is a model nursing home diversion program. Its $23,000 per resident annual cost is a small fraction of the $130,000 average annual cost of a nursing home in New York City.
For further information on Sheridan Hill House or to arrange a visit contact Olga Brito, CSW, Assistant Residential Director for Supported Housing at The Bridge, at 718-328-1490, or email her at email@example.com.