Advocacy Programs Relevant to the Care of Older Adults

ADVOCACY
PROGRAMS RELEVANT
TO THE CARE OF
OLDER ADULTS
BY: ROMMEL LUIS C. ISRAEL III
BY: ROMMEL LUIS C. ISRAEL III 1

SUPPORT SERVICES
• These services are based
under Title III of the Older
Americans Act, Senior
Resources provides funding
for home and community
based services.

• Assisted Transportation
• Provision of assistance, including
escort, to a person who has difficulties
(physical or cognitive) using regular
vehicular transportation.
• Benefits Counseling
This service helps the elderly in
determining their eligibility for income
maintenance or public assistance,
assists in processing or filling out
forms such as insurance, and teaches
about local, state and federal tax
benefits or credits.

• Benefits Education
This category covers those educational programs
designed to make the participants aware of
government or non-government programs available to
assist them in meeting their needs and solving their
problems. These programs address the details of the
services provided, eligibility requirements, and the
places where services are delivered.
Case Management
Assistance either in the form of access or care
coordination in circumstances where the older person
and/or their caregivers are experiencing diminished
functioning capacities, personal conditions or other
characteristics which require the provision of services
by formal providers. Activities of case management
include assessing needs, developing care plans,
authorizing services, arranging services, coordinating
the provision of services among providers, follow-up
and reassessment, as required.

• Chronic Disease Management
A program designed to help people with
chronic diseases to gain self-confidence in
their ability to control their symptoms, take
on health challenges and maintain control of
their lives.
• Companion
Service intended to provide company to a
participant in a protective and supervisory
capacity. It may include such home
management activities as cooking and light
housekeeping.
Continuing Education
Service designed to provide the elderly with
an opportunity to acquire and/or improve
their knowledge and skills through a formal
or informal mechanism of meetings, training
sessions, seminars and workshops.

• Day Care
Provision of personal care for dependent
adults in a supervised, protective, congregate
setting during some portion of a twenty-four
hour day. Services offered in conjunction
with adult day care frequently include social
and recreational activities, training,
counseling and meals for adult day care
participants while at the facility. Service such
as rehabilitation, medications assistance, and
personal care assistance are also provided by
some adult day care programs.
Dental Clinics
Clinic programs that offer dental screening
and/or treatment.

Employment Assistance
This service designed to help participants
locate and qualify for gainful employment.
Employment Counseling
This service assists the elderly in their
adjustment to retirement through pre-
retirement programs or a more crisis-
oriented service for retirees. This service
may also include advice about employment
and enhancement of employability.

Fall Prevention
A service designed to assess fall risk factors such as balance and gait
impairments, postural hypotension, medication use, vision impairment
and environmental hazards including unsafe footwear or assistive
devices. Consumers are counseled on appropriate steps to take to reduce
their risk for falls and are provided educational materials. Fall prevention
may also include programs that incorporate strategies to reduce the fear of
falling, increase physical activity levels, increase strength and balance, and
address environmental changes to reduce falls.
Family Life Education
This category is provided to cover those education or training programs
that deal with family and individual adjustment. It provides participants
with the skills required to cope with the psychological and societal
problems spawned by advancing years.

• Energy Related Assistance
Service designed to furnish fuel and/or utilities to
participants who are unable to purchase them at the
market price. Special arrangements are made with fuel
and utility suppliers to reimburse them for the delivery
of fuel or the provision of utilities at prices negotiated
at or below the market price. The elderly participants
or their families are expected to share costs at levels
determined by their economic circumstances.

• Friendly Visiting
A service in which volunteers visit on a regularly scheduled basis the homes of
participants who live alone and are socially isolated and/or geographically
isolated. It provides protection and socialization for the participant. The
visitor helps the elderly participant maintain contact with the outside world
by providing such service activities as letter writing and reading.
Health Assessments
Service designed to develop an individualized profile of participants’ current
health and the services required to maintain or improve their
functioning. Service may be provided by a medical doctor or a diagnostically
trained nurse practitioner or physician’s assistant.
Health Counseling
Service designed to provide individuals with an awareness of preventative,
remedial and/or rehabilitative self-health care focused on the particular
health needs of participating individuals.

• Health Education
Service designed to provide individuals or
groups of participants with an awareness of
preventative, remedial and/or rehabilitative
self-health care depending on the health
needs of that particular individual/group.
Health Screening/Clinic
Service is designed to promote and maintain
community health by providing testing
services for the assessment of a participant's
health status and the determination of need
for further health care.

• Home Health Aide
Service is designed to provide personal assistance,
stand-by assistance, supervision or cues for persons
having difficulties with one or more of the following
activities of daily living: eating, dressing, bathing,
toileting, and transferring in and out of bed.
Home Repair & Renovation
Service designed to help participants make essential
repairs to their homes either to restore them to their
original condition or to make them safe by removing
health hazards. Includes renovations designed to
remove architectural barriers and provide structural
improvements that will enable participants suffering
from chronic disabling conditions to remain in their
own homes.

• Hospice
This category refers to family and home-oriented
palliative care which focuses on emotional and
psychological support for an understanding of the 60+
incurable disease victims. This care includes
pharmaceutical services, bereavement counseling,
volunteer visits, training and visits by social workers,
counselors and ancillary medical personnel.
• Legal Assistance
Provision of legal advice, counseling, and
representation by an attorney or other person acting
under the supervision of an attorney.
Medical Transportation
Specialized service to provide participants with
transportation to and from destinations that provide
medical services. May include assistive technologies
for persons with mobility limitations.
Medical Visit
Medical visits provide physician or nurse practitioner
care either in the home or in a clinic setting.

•
Medication Management
A group of educational and/or screening
services that optimize outcomes for
individuals related to their medication use in
order to prevent medication errors and
adverse drug reactions. Services are based
upon the responsibilities within the licensed
pharmacist’s, or other qualified health care
provider’s, scope of practice.
Mental Health Counseling
This service is designed to provide psychiatric
care and counseling to persons in danger of
institutionalization or who may have suffered
significant losses, dementia, depression,
etc. Pharmaceutical therapy is available in
addition to counseling when needed. A
psychiatrist is available for home visits.

• Nursing Visits
Service designed to provide part-time preventative,
restorative and rehabilitative nursing care, including health
education and counseling to participants who can be cared
for at home.
Nutrition Assessment
Service designed to develop an individualized profile of
participants’ current nutritional Status and the measures
required to overcome any deficiencies uncovered. Service
must be provided by a dietitian registered with the
American Dietetics Association or other health care
professional with comparable training.
Nutrition Counseling
Provision of individualized advice and guidance to
individuals, who are at nutritional risk, because of their
health or nutritional history, dietary intake, medications use
or chronic illness, about options and methods for improving
their nutritional status, performed by a health professional
in accordance with state law and policy.

•
Outreach
Interventions initiated by an agency or organization for the
purpose of identifying individuals with unmet assistance needs
and encouraging their use of existing services and
benefits. This service includes both the initial contact and any
follow-up contacts required to link the participant to
appropriate services.
• Personal Reassurance
Service provides telephone or personal contact at a
prearranged time for participants who live alone. It ensures
their health and safety, assures them that help is available if
and when needed, and provides community contact over a
sustained period of time. This service includes a mechanism to
investigate if the participant does not answer the telephone or
does not otherwise respond at the prearranged time.
Physical Activity
Physical activity programs focus on key areas important to the
health and fitness of older adults such as stretching and
flexibility, low-impact aerobics, strength training, and
balance. These programs may also include components that
include group-based problem solving methods and strategies
that integrate physical activity into everyday living.

REFERENCE:
HTTP://WWW.SENIORRESOURCESEC.ORG/PROGRAMS-
SERVICES/COMMUNITY-BASED-SERVICES
• Shopping Services
Service helps participants to obtain food and other basic
necessities in the interest of safety and convenience. This
service could involve taking the participant shopping if he/she
is able to leave home, or doing the shopping for participants
who are not able to get out. Deference should be given to the
participant's preferred merchants and to convenience.
Social Support Services
Services which assist participants in adjusting to problems in
their personal lives or living environment. They include
guidance and assistance in such areas as personal adjustment;
marital problems; alcohol or drug dependency, family
relations and adjustment counseling. This service includes
active intervention in the participant’s social environment in
order to assist the participant in producing an appropriate
adjustment. This category covers generic or psycho social
adjustment counseling.

ADVOCACY FOR OLDER
ADULTS
Coalition of Services of the Elderly
Vision
An equitable society for all ages where older persons live in
dignity, remain healthy, self-reliant, secure and free to
commit themselves to others and society.
Mission
To work with older persons, especially the poor and
marginalized, in upholding their rights while respecting
cultural diversity, nurturing their potential, recognizing them
as a significant sector and ensuring their participation in
matters affecting their lives.

Goals
• Development of strong older persons
organizations (OPOs) that uphold
their rights and address the issues of
poverty, exclusion, and invisibility.
• Strengthen partnerships with various
stakeholders to advance the well-
being of older persons.
• Enhance COSE’s institutional capacity
as a resource-based organization on
aging.

ADVOCACY
• Everyone thinks that they know what old age is like
and what older people want and need. But there is
only one group of people who really know what
matters to them—and that is older people
themselves
• A few older people, usually those who hold or have
held important positions in their lives, are still able
to have an impact and get their messages across.
This is because they have access to information,
good contacts with decision makers and have
experience with formal meetings, speaking to the
media, negotiating and working with big
organisations. But for most older people, especially
disadvantaged older people, the picture is very
different. They feel very remote from people in
power, they do not feel well informed or confi dent
to speak up when ‘important’ people are talking
about them.

• Raising awareness of decision makers,
donors, the public, older people themselves,
nongovernmental organisations (NGOs), and
other relevant groups, about how important
it is to ask older people will help ensure
sustainable impacts of local level work.
Furthermore, increased awareness will
empower older people to take on their own
issues in a more receptive, supportive and
informed environment.
• Advocacy with older people raises
consciousness and helps to organise older
people and local communities. NGOs play an
important role in increasing older people’s
level of awareness of the resources available
to them, community support, and the
opportunities they have to help themselves.
Some older people might not even be aware
of their basic rights, such as their right to
clean water or a better quality of living.

WHY ADVOCACY WITH
OLDER PEOPLE?
• The goal of advocacy is to promote
change – changes in attitudes,
policies and actions. Older
people’s issues have been a low
priority for government and non-
government bodies at a time
when older people have become
increasingly marginalised from
their families, communities, and
the development process for a
variety of reasons.

ADVOCACY AND
AWARENESS RAISING
• Advocacy and awareness raising
towards eventual changes in
attitudes, policies and actions
does not occur with just older
people and governments, nor
just with NGOs and
governments. Involving several
groups is a key to success.

THE PUBLIC
• Influencing public
opinion and increasing
awareness in the public is
important to change
perceptions of older
people and challenge the
widely held opinion that
they are a burden – not
contributors – to society.

Many methods can be used to provide information
and positive images of older people to the public,
such as:
• Distributing printed materials such as posters, calendars, leafl
ets, etc. with information and positive images of older people
• Working with media to change how they represent older
people.
• Holding events and celebrations featuring older people – not
just well-known older experts or leaders, but some of the many
poor or uneducated older people who make outstanding
contributions to their communities.

OLDER PEOPLE
• Methods used to increase awareness among older people include
self-help groups, media, seminars and panel discussions, and
intergenerational projects involving schools. It is important for
ageing to be on the agenda of other organisations and
governments. Advocacy targeted at other groups will be fed back to
older people and give them a greater sense of confi dence knowing
that other groups are acting on their behalf.

NGOS AND
SERVICE
PROVIDERS
• Raising awareness with NGOs and
service providers will increase
interest and ultimately inclusion of
older people in their existing
programmes, and the potential
development of services targeting
older people. Advocacy efforts
should target NGOs and
organisations that do not have
ageing issues on their agendas.

POLICYMAKERS, GOVERNMENT
LEADERS, KEY DECISION MAKERS
(INCLUDING DONORS)
• This group should be targeted with general
information (your information for the public) so that
they become more aware of older people and their
contributions and issues. Invite them to your events,
include them in your distribution of materials. It is also
helpful to approach them with specifi c projects or
policy ideas
• It is important to understand existing rights and
entitlements of older men and women. You can do this
by reviewing the policies and commitments the
donors, governments and service providers, you are
working with, have made relating to both older people
and vulnerable groups in general.

• Advocacy efforts must continually work to
sensitiZe organisations to the needs of older
people. NGOs and service providers that are
well-informed and interested in issues of
older people will, in turn, advocate with
other groups and empower older people to
participate in policy processes.

CHANGING POLICIES AT
DIFFERENT LEVELS
LOCAL LEVEL
• In beginning your work with older people to
change policy, it is good to start with small,
specific, local issues that affect them directly.
This will help to assure the participation of
older people, and small successes will create
hope. As the skills and experience of older
people and your organisation increase, you
can work up to larger issues.
• Here are steps you could use to change
policies at the local level:

Help older people
organise to help
themselves.
Support older people in identifying a
policy of any group or even person that
they want to change. Help them see
the link between ‘problems’ they
might identify and the policy decision
behind the problem, and to clearly
identify the policy change that they
want.
Let community leaders know
about what you are doing, and
get them involved. Promote
dialogue between local leaders
and older people—invite them to
your meetings, and activities, etc.
Spread information (raise
awareness) in the local
community about your
issue. Is anyone else
concerned that might
want to join your cause?
Inform the group or
policymaker about
the issue and the
desired change.
Use collective
action to infl
uence the decision
Make sure the
policy change
means a change in
practice or action!

PROVINCE/STATE OR NATIONAL LEVEL
• When working at the province/state
or national level, the process is
usually more complex. More people
and groups should be involved, and
the process will usually take longer.
• Here are some suggestions for
working at this level:

• Be persistent! Don’t give up—it takes time to make changes
at this level!
• Get key decision makers involved.
• It can help—sometimes—to start at the level of the
community then move to the state/provincial level, and
then national.
• Develop a strong relationship with a person in the national
government to learn what their concerns are, and offer
advice.
• Relate your advocacy to their interests, policies and
commitments.
• Involve government decision makers in your meetings and
trainings.
• Offer concrete—but fl exible—goals and policy suggestions.
• Use local level examples to provide evidence why the policy
is needed or should be changed.
• Network with other NGOs to help fi nd common goals and
projects.
• Keep on advocating! Just because a policy is passed doesn’t
mean it will be implemented.

• Reference: https://www.helpage.org/silo/files/advocacy-with-
older-people-some-practical-suggestions-.pdf

MENTAL HEALTH OF OLDER
ADULTS
• Older adults face a variety of mental
health concerns, including depression,
anxiety, substance use, trauma, serious
mental illness, and personality
disorders.
• When considering the mental health
needs of older adults, it is important to
acknowledge that mental health
conditions often occur with each other.

• It is notable that when the
researchers stratified the sample by
age, they discovered decreasing
rates of mental health disorders
with increasing age. This leveling off
effect can be explained by the fact
that the oldest cohort of adults in
the study adopted a present-
focused state of awareness, sought
the fulfillment of emotionally
meaningful goals, and spent time
with familiar social partners.

TYPES OF MENTAL HEALTH
PROBLEMS OF THE OLDER ADULTS
• Depression and anxiety
• Substance use
• Trauma
• Serious Mental Illness
• Personality disorders
• Hoarding
• Suicide
• Subsyndromal conditions

MENTAL HEALTH PROGRAM
• Individual psychotherapy is offered in a
variety of settings ranging from private
practices to community-based services
to professionals integrated in primary
care. Psychotherapy is also offered as
part of broader, structured programs
that can be implemented by a variety
of professionals in community-based
or medical settings.

THE FOLLOWING ARE WELL-RESEARCHED
EVIDENCE-BASED PROGRAMS THAT
INCLUDE PSYCHOTHERAPY:
• Healthy IDEAS (Identifying Depression
Empowering Activities for Seniors)
-Healthy IDEAS is a depression self-
management program designed to detect
and reduce the severity of depressive
symptoms in older adults with chronic
conditions and functional limitations. It
includes screening and assessment,
education, referral to appropriate health
professionals, and behavioral activation.

Program to Encourage Active, Rewarding
Lives for Seniors (PEARLS)
-PEARLS is a highly effective method
designed to reduce depressive symptoms
and improve quality of life in older adults
and in all-age adults with epilepsy. During
six to eight in-home sessions that take
place in the client’s home and focus on
brief behavioral techniques, PEARLS
counselors empower individuals to take
action and make lasting changes so that
they can lead more active and rewarding
lives.

Prevention and Management of
Alcohol Problems in Older Adults
-The brief alcohol intervention
approach is designed specifically for
older adults and uses motivational
interviewing to enhance participants’
commitment to change their
behavior. The program includes
alcohol screening, assessments, brief
interventions, and a guide to referral
for more intensive care.

Brief Intervention and Treatment for
Elders (BRITE)
-BRITE is a substance abuse screening
and intervention program for older
adults who are experiencing issues with
alcohol, prescription medication, over-
the-counter medication, or illicit drugs.
The program aims to identify non-
dependent substance use or prescription
medication issues and provide effective
service strategies prior to an individual’s
need for more extensive or specialized
substance abuse treatment.

Improving Mood—Promoting Access to
Collaborative Treatment (IMPACT)
-is a primary care, team-based program
that includes psychotherapy and rigorous
symptom monitoring via a care manager
for older adults with depression. It is a
long-term intervention, lasting several
months or over one year.
• Reference:https://www.ncoa.org/center-for-healthy-aging/behavioral-health/behavioral-health-programs-for-older-
adults/#:~:text=Healthy%20IDEAS%20is%20a%20depression,health%20professionals%2C%20and%20behavioral%20activation.

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