Best Practices – Specific services

(i.e. exclusively for ageing drug users)

Barcelona, Spain (ES) –

PAAC: Programme for the Care of Elderly Consumers

PAAC was created in 2015 for the population of Horta Guinardó and Vallarca, with the purpose of responding to the growing demand of elderly patients with consumption problems with or without concurrent psychiatric problems. All patients are treated in the Addictions and Dual Pathology Section of the Vall Hebron University Hospital. The programme uses a quick and bidirectional referral system with other hospital services, such as Neurology, Hepatology, Neuropsychology, the Sleep Unit et cetera. This enables the programme to carry out an integral treatment of these patients. They do accept patients referenced by hospitals from other cities, though this poses some logistical difficulties and it is recommended for other hospitals to implement such programs for themselves.

Target group

The PAAC programme is accessible for people aged 65+ with drug addiction and/or concurrent psychiatric problems. Overall, two user profiles can be distinguished: Drug users who have never received treatment and are either referred to the programme by a medical professional or are forced by their relatives and drug users with a long history of addiction and/or treatment. In 35% of the cases they use 3 or more substances (excluding nicotine and caffeine).

Goals and Methods

Initially, all patients complete a psychiatric assessment and a complete psychological and neuropsychological evaluation which consists of 3 consecutive visits during the first month of treatment. This assessment is done through a large number of different tests, which try to determine presence of psychiatric disorders, ADHD, addiction severity, impulsivity, eating disorders, sleep disorders and the neuropsychological evaluation consists of tests that focus on memory, attention, recognition, phonetic fluency, processing speed, problem-solving tasks, visual fluency and cognitive flexibility. After this, psychiatric and psychological follow-up is done by periodic visits (bi-weekly/monthly) according to individual needs. Patients are also monitored by nurses on toxic controls, basic hygiene habits, diet, sleep et cetera and this information is related to the social worker in charge.

 

What makes this good practice example special?

The programme is linked to an outpatient center that also focuses on harm reduction services. This means that there are still services accessible to people of all ages, yet the key characteristic is the tailored program specific for elderly patients with consumption problems. They also take into account that these patients often show a more complex set of problems that requires a thorough examination and more follow-up visits, especially in the first phase of the treatment.

 

Contact information

PAAC programme
C: Elena Ros Cucurull, Psychiatrist.
M: elenaroscucurull@gmail.com
A: Passeig Vall d’Hebron 119, 08035 Barcelona, Spain.
W: http://www.vhebron.net/

 

 

Keywords:
For who: ageing drug users, aged 65+
Service: Out-patient, opioid substitution, neuropsychology, specialized medical services, ongoing psychiatric support
Treatment: Counselling, harm reduction, activation, group therapy, social support
Staff: Nurses, medical doctors, psychiatrists, psychologists, social workers, peer workers (paid), community educator
Funding: Public

Walferdange, Luxembourg (LU) – TABA

TABA is a structure-giving employment offer for older drug users.  Drug use is tolerated without obligation to be in substitution treatment, however access to gain such treatment is supported by the project. The service is free for clients, the only expense is the time clients spend in the project and individual travel expenses. The project facility is far away from the drug scene (15km) and easily accessible by bus/train and services a group of (on average) 15 individuals. The employees are experienced drug workers with at least 10 years of experience working with drug users. They have all previously worked in a low threshold center for drugs (ABRIGADO) and are of similar age to the participants.

Target group

The project is accessible for problem drug users aged 40+ and accepts clients with concurrent psychiatric problems, physical impairments and cognitive impairments, depending of the severity of the disease and the ability of the group to deal with it. For homeless client or those without income, travel expenses are payed for though a monthly bus pass.

Goals and Methods

TABA focuses to interrupt the routines and distance to the drug scene, providing daily structuring, reduction of social isolation, promotion and rediscovery of own competencies. Additionally, they strive to provide meaningful occupation, appreciation and participation while confronting clients with their consumer patterns and associated responsibilities and the ‘handicap’ of addiction. Clients will participate in the project for 3 days per week and participation is voluntary and unpaid. Clients are supported to get access to medical services, hospitals and the first or second labour market.

 

What makes this good practice example special?

Their focus on full acceptance without forcing abstinence, low threshold access with individual working hours based on the resources of the participant. Participants work voluntarily and unpaid and the framework is intended specifically for elderly and willing drug users. The specific needs of clients are addressed through crisis support and the project works closely with other services which allows for referral to housing solutions and/or substitution programs for example.

 

Contact information

TABA
C: Patrick Klein, Manager/Nurse.
M: patrick.klein@cnds.lu
A: 34 Rue Josy Welter, 7256 Walferdange, Luxembourg.
W: www.cnds.lu

 

Keywords:
For who: ageing drug users, aged 40+.

Service: In- & out-patient, drug use tolerated, activation, work projects
Treatment: Counselling, medical and mental care, social care, harm reduction, activation
Staff: Nurses, psychologists, peer workers, educators
Funding: Public funding, donations

 

Antwerp, Belgium (BE) – Live-in Care Center (WZC) Bilzenhof

Bilzenhof is a live-in Care Center (nursing home) for the elderly in need of physical and psychological care, provided by the organization ‘Zorgbedrijf Antwerpen’. It is situated in a multicultural neighbourhood where a lot of people are in a vulnerable situation through poverty, substance abuse, isolation, migration, homelessness and psychological disorders. The care center is specialized to meet the needs of this population. They provide housing solutions for a total of 95 clients, divided into three ‘care groups’. One group, housing 27 clients is intended as a ‘closed’ department, specifically for those clients that present severe cognitive deterioration, whereas the second group of 27 clients is intended for those that predominantly have physical care (somatic) needs. The third group, housing up to 41 clients is intended for those with a long pre-existing psychiatric history or with complex social and/or psychological problems. All clients with a history of substance abuse are housed within this third group.

Target group

It is situated in a multicultural neighbourhood where a lot of people are in a vulnerable situation through poverty, substance abuse, isolation, migration, homelessness and psychological disorders. The care center is specialized to meet the needs of this population and rehabilitates people that have exhausted all treatment options, providing them with the needed structure to have a fulfilling life.

Goals and Methods

Bilzenhof works with an individual approach, incorporating a Community Reinforcement Approach (CRA), involving clients (and their social contacts) in the process of determining regulations on their finances, permission to go outside with/without supervision and alcohol and tobacco use, depending on their individual needs, capabilities and deficiencies. Additionally, they promote animation to reactivate clients through talk-groups, sport activities, walking, excursions, parties, reminiscence, reading clubs, cooking, crea and many more activities. Next to that, they stimulate hygiene and appearance to provide a healthy look and feeling. For opioid users, methadone can be given and followed up by medical staff. They strive for minimal use, though recognize that abstinence is not always an achievable goal. In some cases that show a drastic recovery a re-orientation to a service flat is considered a possibility.

 

What makes this good practice example special?

Firstly, Bilzenhof focuses on rehabilitation and making clients feel useful and part of their community. They are open to clients re-orientating to more independent housing solutions when possible whereas in most cases the care center will be their last housing environment. The canteen of this service doubles as a neighbourhood restaurant, offering neighbours the opportunity to eat there and thus stimulates the integration of the care centre within the neighbourhood and vice versa.

 

Contact information

WZC Bilzenhof
C: Rien Beersmans, Psychological Consultant.
M: Rien.beersmans@zorgbedrijf.antwerpen.be
A: Lange Beeldekensstraat 50, 2060 Antwerpen, Belgium.
W: http://www.zorgbedrijf.antwerpen.be/onze-diensten/woonzorgcentra/onze-centra/woonzorgcentrum-bilzenhof

 

Keywords:
For who: ageing drug users, aged 50+
Service: In-patient, assisted living, comorbidity accepted, drug use not permitted within the common areas.
Treatment: CRA, individual case management, methadone treatment, activation, long-term housing solution.
Staff: Nurses, Medical doctors, Psychologists, Social workers, Peer workers (voluntarily)
Funding: Health insurance, public, private.

 

 

The Hague, Netherlands (NL) – Woodstock

The housing solution ‘Woodstock’ was founded in 2008, after Parnassia professionals noticed there was an increasing amount of homeless and addicted persons who were not rehabilitating (kept ‘coming back’) and needed a place to stay. Often, there are no other options available to them because they do not fit into ‘regular’ addictive or psychiatric services (due to somatic problems) or into nursing homes (due to the addiction and/or psychiatric) problems. Therefore, this group runs the risk of ‘falling through the cracks’ and Woodstock tries to address this particular group.

Target group

The goal of this location is providing a calm and safe living environment (protected/assisted living) for persons from the age of 45 years, who have longstanding addiction problems and are homeless. Often the tenants have psychiatric and/or somatic problems (for example COPD) along with the addiction problems. For most tenants, Woodstock serves as a ‘last stop’, so ‘outflow’ or full socio-economic re-integration into society is rare. Rooms become available mostly due to eviction (for severe or repeated misconduct) or the tenant passing away.

Goals and Methods

Woodstock works from a ‘total concept’: Tenants live and work in the housing service, abide by the rules set in place and feel at home through participation. Acceptance within the neighbourhood is another aim. During the phase leading up to the founding of the location there was continuous communication with surrounding neighbours about the concept and its goals and there was a 3-year trial period at first. When it came to the decision whether the location could stay active, there was even a petition started by the neighbourhood to make sure Woodstock would stay. The presence of the service also has a deterring effect: through close contact with the neighbourhood watch, problems are identified and dealt with earlier, which benefits the neighbourhood as well.

 

What makes this good practice example special?

Drug use is tolerated within the tenant’s own room and sharing amongst tenants is also allowed. Substitution by Methadone is provided only after a breath analysis. Depending on the breath analysis score, the dosage of Methadone is altered (Higher score = lower dosage). Currently this is the only location in the Netherlands providing this type of setting for this target group.

 

Contact information

Woodstock
C: Koos Maquelin, Supervisor DHOD
M: k.maquelin@parnassia.nl
A: Om en bij 1, 2512 XK Den Haag, the Netherlands.
W: https://www.parnassia.nl/hoe-wij-helpen/dak-en-thuislozen

 

Keywords:
For who: ageing drug users, aged 45+ AND homeless.
Service: In-patient, nursing home (housing project).
Treatment: Counselling, medical care, social care, substitution therapy, harm reduction, activation programmes, group activities.
Staff: Nurses, medical doctors, psychiatrists, social workers.
Funding: Health insurance, public funding.

 

 

 

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