This paper describes a model of outreach predicated on developing a trusting, meaningful relationship between the outreach worker and the homeless person with mental illness. We describe five common tasks inherent in this model of outreach (establishing contact and credibility, identifying people with mental illness, engaging clients, conducting assessments and treatment planning, and providing ongoing service). Other issues discussed include: (a) Responding to dependency needs and promoting autonomy; (b) setting limits while maintaining flexibility; (c) resistance to mental health treatment and follow-up service options.
Purpose Wandering is aimless or repetitive locomotion that may expose persons with dementia to falls, injuries, elopement, and untimely death. Using data from focus groups, this study obtained opinions on the potential effectiveness of existing technologies for managing wandering in persons with dementia living in the community, and on the elements that such technologies should possess from the user's perspective. Design & Methods Cross-disciplinary, consensus-based analysis was applied to data from 6 focus groups consisting of 7 elderly nursing home residents, 7 caregivers of persons with dementia, 9 home healthcare staff, 7 long term care staff, 7 medical surgical staff caring for dementia patients, and 6 engineers working in rehabilitation settings. Each group received a briefing on available technology for wanderer monitoring systems and elopement management systems. Results Participants in all groups wanted flexible systems that would allow for a normal daily life, accommodate to changes over time, and be inexpensive. Inside the home, motion detectors and weight-sensitive mats by doors were preferred over camouflage and other visual deterrents; outside, Global Positioning System based elopement management was preferred. For both technologies, ranges and sensitivities must be programmable and changeable as environmental and human conditions warrant. Policy Implications 60% or more of the 4.5 million Americans with Alzheimer's disease will wander and wandering predicts nursing home entry. The need for effective technologies to manage wandering in home and formal care settings is underscored by the high cost of nursing home care on the caregiver, his or her family, and government healthcare organizations. These technologies promise to delay nursing home entry and improve care but they must perform reliably, simply, effectively and inexpensively.
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