About the SeniorAdvisor.com 2014 In-Home Innovation Scholarship: We started the scholarship program to bring awareness of the unique benefits and challenges of in-home caregiving for seniors to younger generations. The questions posed by the scholarship encouraged our nation’s future caregivers to present solutions for improving home care in the United States. College-aged students were required to answer one of the three essay topics below and provide a short bio as part of their scholarship application. Read the winning essays here.

How can your major of study improve the lives of seniors receiving in-home care services?

Essay response by Raisa Garcia, Saginaw State University

Clinical psychologists can take on many roles: practitioner, researcher, professor, and many more. Geropsychology has become an emerging branch in the field as more people are living longer. This field of study aims to address the concerns of older adults such as depression, anxiety, grief, and age-related medical or psychological illnesses. With the needs of the public, I see the role of psychologists transitioning from being primarily a psychotherapist in hour-long talking sessions, to more of a consultant. I realized this when interacting first-hand with older adults. My first experience working with the senior populations was from volunteering at hospice nursing homes. Here, I provided extra support to the hospice care team by doing friendly patient visits to terminally ill patients. A year after in my advanced years of graduate school, I gained a clinical placement at a skilled nursing facility where I provided individual, group, milieu, and assessment services to adults and older adults with chronic medical illnesses and mental health disorders. Through these experiences, I saw that in the realm of in-home care services, psychologists could make contributions as a consultation in three ways: (1) providing direct clinical services while challenging what is considered therapeutic, (2) facilitating an inter-disciplinary team approach in services, and (3) conducting research to evaluate effective practices tailored to the older adult population.

Direct Services

Therapy work with older adults in skilled nursing facilities or in-home care services may not look like the traditional picture of therapy, nor should it have to. Older adults have specific needs and it is the duty of psychologists to assess each person’s needs. Psychologists usually start their work with clients through assessments of cognitive functioning. Of course, challenged with the complex diagnoses of clients at my skilled nursing facility, I have learned to draw on creativity in interacting with clients and further assessing their abilities. Aside from utilizing various standard assessment tools, I sometimes challenged clients through games of their own interests in order to explore and access different cognitive skills that otherwise may not be captured. In this way, I could provide both social support to clients while also assessing their cognitive functional needs for treatment planning purposes.

Following the assessments, psychologists can analyze what they can do to best serve clients. Overall, there are many common issues that psychologists can help with, especially in increasing adherence to necessities such as eating, taking medications, and bathing. This can then decrease the risk and likelihood for any hospitalizations due to medical complications. By utilizing behavior-based strategies, psychologists can work to reduce needs for medications that are often used to address behaviors associated with psychotic or dementia diagnoses. Psychologists can also utilize cognitive-based strategies in helping clients process their life adjustments and transitions, both logistically and developmentally. Strategies can involve talk- therapy or other modalities such as community outings, art therapy, or even music therapy.

Interdisciplinary Team

Not all skilled nursing facilities and in-home services are able to include psychologists as part of the team, but when they can, it would be exceptionally helpful. My clinical placement at the skilled nursing facility was very unique in that I was able to attend weekly interdisciplinary treatment team meetings to actively collaborate with specialists representing medicine, psychiatry, nursing, behavioral health, social services, physical and occupational therapy, speech therapy, and dietetics. Through these meetings, the teams were able to assess management of cases and discuss what we could collectively do to better serve clients. Sometimes this involved doing training presentations to staff on various topics including: conceptualizing difficult behaviors (ABC model: antecedent, behavior, and consequences); making cultural considerations in care; and recognizing compassion fatigue and burnout for caregivers. Other times it involved facilitating conflict management between teams (e.g., nursing staff and activities staff) to resolve miscommunication and misunderstanding.

Research

While execution of clinical competencies has been the focus of psychologists, I view their role as an advocate for researching evidence-based practices equally important. In the skilled nursing facility I trained at, I was able to do both process groups (Women’s Group and Men’s Group), as well as a structured dialectical behavior therapy group. This latter group format was modified to our clients’ cognitive capacities and was meant to teach emotional regulation and interpersonal skills. Considering that the literature continued to have little to no research on such an intervention, this modified group therapy became part of a research project that the facility began this year and will continue onto the next.


About Raisa

Raisa received her BA in psychology and behavioral science from San Jose State University (2010), received her MA (2013) and will receive her PhD in clinical psychology (2016) from the California School of Professional Psychology in San Francisco. She has worked in the mental health field since 2010 with individuals across the lifespan. She has also trained in a variety of settings including schools, community mental health clinics, inpatient hospitals, and private practices. Outside of clinical work, Raisa actively volunteers with policy health organizations in hopes of creating systemic healthcare change.

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