community (see “Resources” for suggestions). Avoid inappropriately prescribing antipsychotics to alter behavior in older adults with cognitive impairments.xvi VI. Cultural Competence and Adaptation. Check if your physical space is accessible for older adults (e.g., wider doorways, exam rooms with space for caregivers, handrails, smooth transitions at doorways). Recognize and respect cultural differences with patient and caregiver involvement. Understand the role negative attitudes and discrimination can play for various cultural groups and older adults. Accommodate generational differences in use of technology and cultural acceptance of questioning or not questioning providers. Use formal and informal community resources to overcome geographic and transportation barriers in rural areas. VII. Systems-Oriented Practice. Understand and explain Medicare benefits, including Part D and preventive benefits (e.g., alcohol misuse screening, depression screening)to patients and their caregivers. Coordinate benefits for dually eligible Medicaid/Medicare beneficiaries, including certain social services that are available with lower cost sharing. As the health care landscape changes (for instance, accountable care organizations [ACOs] are established), ensure that a staff member is equipped to help patients understand and use their benefits. INCORPORATE STRATEGIES such as medication reconciliation and prescription monitoring into your EHR to alert providers of medication interactions and overprescribing to avoid associated risks (e.g., abuse, falls, delirium). TRAIN YOUR STAFF TO HELP older patients understand and use their benefits. 10 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS VIII. Practice-Based Learning and Quality Improvement. Measure patient and family caregiver satisfaction. Provide continual staff training related to major competencies and best practices for older adults. Learn to recognize behavioral disorders. Monitor avoidable negative health outcomes that are more prevalent with older adults and implement quality improvement protocols (e.g., injuries, infections, adverse reactions to multiple medications). IX. Informatics. Establish electronic health records that include multiple providers, all prescriptions, social service notes and clinical decision support tools. Use large print informational materials. Ensure kiosks and other touchpad technologies have large buttons. Address privacy concerns related to sharing health information. Evidence-based guidelines are a great resource for identifying clinical, organizational and systems level changes to improve care for older adults. The National Coalition on Mental Health and Aging has compiled a directory of competencies, standards and guidelines for providers working with older adults encountering behavioral health concerns. Many other national provider organizations have practice guidelines and protocols to consider when working with older adults (See the resource list at the end of this document). THE ROLE OF THE COMMUNITY Primary care providers are not alone in caring for the aging population. Caregivers, neighbors, friends and community-based organizations also play a vital part in supporting older adults’ primary and behavioral health. Rural communities with workforce shortages are of special concern and older adults may have to depend on community partnerships and existing informal networks of friends and neighbors to promote healthy behaviors and allow them to remain in their own homes and engaged in community life. As part of care coordination, providers must know the community resources equipped to address social determinants of health, elder abuse and isolation, and appropriately connect patients to those services. Your community may have the following organizations and services available to serve as partners in the health promotion and disease prevention of older adults: • Adult protective services • Nutrition programs • Senior centers • Transportation services The Eldercare Locater can help you find these resources in your community. In addition, Mental Health First Aid for Older Adults provides community members with the required tools to identify a behavioral health problem and get