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Cattaraugus County's Evidence-based Intervention Plans

Cattaraugus County, a rural county in western NY, draws from six distinct evidence-based programs in its work with older adults and their families.

"The offices for the aging are playing a growing role in the implementation of evidence based interventions that have shown to reduce health care costs, out-of-pocket costs for individuals and improve health outcomes," said the New York State Office for the Aging's (NYSOFA) Acting Director Greg Olsen. "Embedding these interventions in the aging network furthers the nation's agenda in focusing on prevention and cost-avoidance. There is no better partner than the offices for the aging because of their strong community presence and their vast relationships with diverse organizations and providers."

Staff in the field are also standing behind these model programs.

"I really believe in these [EBI programs]. We have seen them drastically change a person's life for the better," said County Office for the Aging Director Catherine Mackay.

County Department of the Aging case manager, Ellen Herner, is lead case manager for a number of the county's EBI programs, and uses four model programs in her practice, said Mackay.

Described by Mackay as "…a perfect fit for the one-on-one programs," Herner leads the county's PEARLS (Program to Encourage Active, Rewarding Lives for Seniors), Powerful Tools for Caregivers, and Hoarding programs and is the primary coach for the Care Transitions program.

Like all aging network case managers, Herner meets with older adults in their home to assess their individual needs, mobilizes resources to meet those needs, and provides ongoing contact and coordination. The tools available to her through EBIs complement and enhance this work. EBIs offer proven ways to address problems encountered by case managers such as depression, caregiver stress, transitioning from hospital-to-home and hoarding.

One example: fighting hoarding
A specific example of the challenges facing many older adults and community service providers is "hoarding and acquiring." Many factors increase the likelihood of this problem within older populations, including becoming less able (physically or cognitively) to maintain a home and belongings, acquiring more "stuff" as the years pass, and less available space as a result of downsized living arrangements.

According to the International OCD Foundation, hoarding is a complex disorder that is made up of three connected problems: 1) collecting too many items, 2) difficulty getting rid of items, and 3) problems with organization.

When an older citizen's home becomes overfilled and contains health hazards, the ability to bring services into the home is compromised. This kind of home environment poses safety risks and increases the likelihood of falls. The usual way for agencies and individuals to address the problem of hoarding involves ultimatums, bringing in a dumpster and forcing a clean-out.

In Cattaraugus County, staff experience shows that, historically, this approach did not usually resolve the underlying "hoarding" issues, or provide the tools to make changes. The problem often recurred with the same individuals again amassing items and cramping their living space.

The search for a better approach led the case manager supervisor to a model program with printed and on-line resources. "Compulsive Hoarding and Acquiring: Therapist Guide and Workbook (Treatments That Work)" by Gail Steketee and Randy O. Frost features a special form of cognitive behavior therapy that has been developed to treat hoarding. Several outcome studies of cognitive behavior therapy for hoarding have shown it to be an effective treatment.

Utilizing this approach has provided the case manager with tools and has lessened the frustration of recurring problems.

Cattaraugus County Department of the Aging has become a resource for other service providers in the area who encounter older adults challenged by hoarding. Staff also present on this topic to community groups.

Resources

The International OCD Foundation Hoarding Center(External Link) website contains information and resources on hoarding and features the model highlighted in this article.

The Anxiety and Depression Association of America(External Link) has devoted a section of their website to information about hoarding.

Visit the Cattaraugus County Department of Aging(External Link) for more information on services available in the county.