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Guiding Principles for Service Providers Helping Seniors Who Have Alcohol Problems

People stressed the need to respect the person. This is a person first, and secondly, a senior with a specific problem (in this case, an alcohol or another drug misuse or dependence problem). They stressed the need to see the person behind the presenting problem. As part of that, they pointed out the need to deal with problems holistically. An alcohol problem is often only part of the senior's problems.

They also pointed out the importance of understanding that problems that developed over a long time are unlikely to get fixed overnight. They stressed the importance of taking the time.

You will need to respect the senior’s right to live at risk of different kinds of harm and the senior's right to make choices that you may disagree with. They underscored the need to understand the nature of alcohol dependency, and how it can affect a senior's choices. Recognize the role alcohol is playing in this person's life. Don't take away one coping mechanism (alcohol) without making sure there is a better coping mechanism in place.

They pointed out that you should not wait for a crisis before responding and offering help. A senior may not survive the crisis. They emphasized that you should not try to "unbuild" or dismantle the senior’s life. Accept the person where he or she is. Also, understand that circumstances can change rapidly. A senior with an alcohol problem who you thought was doing well, can quickly deteriorate. Most importantly, they stressed don’t be discouraged. The effort is well worth it.

Below are a number of Best Practices Guiding Principles that have been developed by the Seeking Solutions project, with many of these starting points in mind.

Best Practices Guiding Principles

  Best Practice information sheet on Guiding Principles  (PDF version) summarizing or elaborating on many of the points below.

It can be helpful to have a few starting points to guide you when counselling, offering other types of help or when planning and implementing resources in the community for older adults who have alcohol problems. People across the country have found that these approaches work well with seniors who are experiencing an alcohol or medication abuse or misuse problem.

1. Build Trust

Having an alcohol problem can make an older person feel alone and unsure of himself or herself. It is very important to continuously support, facilitate, and motivate the person.

Starting Points

- Use approaches and opportunities such as visiting the person at their home to reach out to the person.

- Take the needed time to build rapport and trust

- Draw on that trust by being available at key points (for example, that may mean accompanying them for the first time when they are meeting a new service provider, seniors' group or other resource for the first time.)

2. Be Flexible and Accessible

Any addiction or other health service being delivered must be accessible to the senior to be of any use. That means the service will need to address any physical, social, emotional and geographical barriers to service.

In reaching out and offering help to older adults,

• recognize they may need more time and give them it,

• go at their speed (which may mean going much slower), and

• focus on their needs.

Starting Points

- Recognize the differences among seniors (they are not all the same)

- Listen to older adults to find the gaps in and barriers to addiction and other services in your community or region.

- Design and provide services that are appropriate and relevant for this population.

When evaluating programs, look at the program from the older persons' perspectives, particularly for indicators of “success”.

3. Understand and Respect the Older Person

People demonstrate respect in many ways, including by acknowledging older adults’ need for independence and control over their own lives. People show respect in the language they use and the ways that they act towards the older adults (including whether they see themselves or the older adult as the “expert” in the situation).

People also demonstrate respect to older persons generally when they are sensitive to cultural, community and generational differences, and when they turn to older people for ideas on how to effectively reach older adults in their community.

Starting Points

- Listen to the person.

- Reinforce that the alcohol problem has nothing to do with personal weakness.

- Avoid labelling language such as “alcoholic”, "alcoholism", "co-dependency" or “enabling” when talking with the older adult or with others.

- Use approaches that help promote wellness.

- Avoid imposing your own personal or professional values on the person‘s goals.

- Be sensitive to the complex and novel ethical issues that can arise in the context of helping.

4. Take a “Whole Person” Approach

Alcohol as a problem seldom exists in isolation. There are frequently many interrelated difficulties in the older person’s life. It is important to take into account all aspects of the person’s physical, psychological, social, financial and spiritual needs.

At the same time, alcohol is only one facet of this person’s life. It is important not to constantly dwell on it, but look to other parts of the person.

Starting Points

- Place any discussion of alcohol issues in a normalizing context.

- Do not talk with the person only in the context of discussing his or her alcohol problems. The person is not the label. There are many other sides to this person.

- Use humour and other positive techniques to lighten up the discussion, and facilitate what can otherwise be an anxious atmosphere.

- Give the person opportunities to express and show parts of his or her life, strengths, skills, capabilities etc.

  5. Recognize the Older Person’s Needs

Older adults have all the psychological needs that other people have, including the need to be wanted, needed, and valued. Older adults are often experiencing many losses in their lives, including loss of a spouse and friends, and loss of job or other important roles.

Older adults who are experiencing alcohol problems are a very diverse group. Older women and older men often face different types of experiences, as do younger and older seniors, rural and urban seniors, seniors who are members of an ethnic or cultural minority group etc.

It is important to recognize the needs of older adults with an alcohol problem will be different from older adults who do not have one. Their needs are also different from the younger people who have an alcohol problem.

Many older persons experiencing an alcohol problem have become very isolated because of their physical, psychological, social or economic condition. Typically helping will mean taking active efforts to reach and support them. It means providing services that are readily available, user- friendly, flexible and accessible. This may include offering outreach, home visiting, telephone support, as well as assuring there are reliable ways to get the person to services and to help them reconnect in the community.

Starting Points

- Start by helping to meet the person’s basic needs.

- Focus on ways of reducing distress for the person.

- Recognize  small successes with the person, and build on them.

- Recognize that what you or others want to change in the situation may not match the older person’s priorities.

- Recognize and address barriers such as transportation.

6. Be an Advocate

Seniors experiencing alcohol problems can easily have their needs overlooked or ignored by service providers and others. Seniors experiencing alcohol problems are sometimes discriminated against, and it can be necessary to push simply to get their basic needs met.

Also, it can often be difficult for an older adult to let others know what he or she needs to improve the situation. As a result, it is important to help older adults speak on their own behalf, as well as speak on their behalf to get those needs recognized and addressed.

People working outside of addictions services (and in many cases, those working in it as well), may want older persons to stop drinking before giving them other types of help they need. This is often not possible, or warranted. People will often need to be strong advocates for older persons to help change policies in hospitals, emergency, addiction services, long term care facilities, day programs, housing programs etc. that can act as a barrier to the person getting the different kinds of help and services needed.

Starting Points

– Recognize and actively counter the stereotypes that exist about aging or about alcohol problems.

– Actively question “neutral “ policies in addiction, health and community services that discriminate against or act as a barrier to an older person receiving help.

7.  Work with Others

To effectively take a “whole person approach”, usually means drawing on the skills of a variety of community resources, professionals, and support services to provide a comprehensive range of community-oriented services to the older adult. This means there is a need for collaboration between volunteer and formal organizations, as well as inter-agency cooperation, working together in an integrated way.

Starting Points

- Recognize that no one service provider can tackle all the issues alone.

- Whatever service you are offering, avoid working in isolation.

- Look for natural partners in your community such as mental health workers, and pharmacists.

- Also look for help in the context of other community and seniors’ services.

- Provide those connected to the older adult with feedback to build hope and promote the feeling that change is possible.