Stepping Stone partnership with LOFT: a first step to aging at home

For many seniors with mental illness and/or addictions, their wish to 'age at home' is not an easy one to grant.

Not only are such clients often unready for long-term care placement, their sometimes challenging behaviours can mean they are not preferred tenants in traditional forms of independent seniors housing.

Through an exciting partnership with LOFT Community Services, CAMH’s Stepping Stone Project has been able to house geriatric clients with mental health and/or addiction issues who might otherwise have remained in hospital. The majority typically has a schizophrenia diagnosis, but their symptoms are mostly stabilized. Many have been in the mental health and addiction system for a long time, either institutionalized or marginally-housed with few family or community supports.

William Shin, coordinator, Stepping Stone project, with a client who now lives in the community thanks to an exciting partnership between CAMH and LOFT Community Services.

Now entering its second year at John Gibson House in Toronto's west end, LOFT and CAMH’s Stepping Stone Project provides high-support housing for at-risk and frail older adults in the community. Six beds at John Gibson House are reserved for CAMH client referrals and six others are for other community hospitals. CAMH staff – including a psychiatrist, a nurse, and an occupational therapist – visit weekly to provide the intensive level of specialized support needed. As much as possible, CAMH staff remain involved with the clients after they move into permanent housing to maintain the continuum of care.

Dr. Tarek Rajji in CAMH’s Geriatric Mental Health program believes the Stepping Stone Project is important because it allows seniors to live more independently while the supports built into the project prevent future hospitalizations.

“Some of the clients have been institutionalized since the 1990s, and there were concerns they wouldn’t be able to adapt to community living. However, through the continuity of care offered to the clients, we were able to prevent their functional, social and psychiatric decline as they transitioned to the community.”

Saving the sandwich generation

While many people in the ‘sandwich’ generation are struggling to ensure the needs of their children and their elderly parents are met, imagine the worries they have if their senior family members have serious mental health issues.

Dr. Rajji has seen family relationships renewed or improved once the seniors’ housing has been stabilized in the community. In one case, he saw the relationship between a female client and her son and grandchildren greatly improve once the client was found a placement through the LOFT system.

Getting the Stepping Stone Project off the ground was the result of a great deal of strategic planning and cooperation by CAMH’s Physician-in-Chief and Clinical Director of the Geriatric Mental Health Program, Dr. Benoit Mulsant, and LOFT’s CEO Terry McCullum. Both were committed to improving the quality of life for clients who don’t require acute hospital care and for whom assisted living is inappropriate. They worked together to create an innovative solution where no prototype or template had existed.

As a result, the Toronto Central LHIN, funder of the program, has asked that the program place another 30 clients going into its second year. The diversion of clients out of hospital has led to a reduction in alternative level of care (“ALC”) rates, improved system capacity and a new outlook on life for our senior clients.