Policy shifts in the detention of illegal immigrants could offer new opportunities for behavioral health and social service provider organizations. I read with interest the October 6 report by Dr. Dora Schriro, former Special Advisor on Immigration and Customs Enforcement (ICE) and Detention & Removal, "Immigration Detention Overview and Recommendations," where she announced new recommendations to revamp the currently fragmented, insufficient immigrant detention system. The basis of her recommendations is that using jails and prisons is costly—and often unnecessary—for detention, and that specialized privately-run facilities might be the answer.

In total, the U.S. government spends $2.4 billion annually on its current ‘detention and removal' system. Even a diversion of a small part of that budget for community-based and situation-appropriate settings could be a big opportunity in the field. Some of the specific recommendations that caught my eye include:

• Non-governmental organizations and non-profit agencies should be invited to assist eligible individuals in special populations, as well as the general population, to establish community ties and develop viable release plans to qualify for placement in ATD programs
• ICE should develop specialized caseloads of aliens including those chronically, medically, or mentally ill or have been detained a significant length of time to improve case management and expedite removal, release, or relief.
• More ADA-accessible facilities should be available to house detainees with special needs. Specialists to diagnose and treat each of these populations, specialized case management, and prescription reviews are all needed.
• Aliens with mental illness would benefit from improved staffing, appropriate housing, access to step down services, and specialized case management.
  
  You can read more on this in "U.S. Moving Away From Correctional Model for Immigrant Detention; New Ideas Include Expanded Use of Hotels & Nursing Homes." As the plans for restructuring the immigration detention system become more concrete, look to our team at OPEN MINDS for continued coverage of new opportunities.

The New York Times recently had a piece, "Patient Money: When Elder Care Problems Escalate, You Can Hire an Expert," on the challenges of getting good advice when it comes to caring for elderly parents. The author recommends families hire a geriatric care manager, and adds that

"you must pay these professionals out of your own pocket. Regular insurance does not cover them, although some long-term care policies do. But a good care manager can buy you time and some peace of mind so you can concentrate on your job, your family and your own health."

In addition, the article comes complete with rates—$100 to $200 for consultation; $500 to $1,200 for assessment; and continuing case management by the hour.

I don't see many of the behavioral health and social service organizations I work with preparing to provide in-home support consultations and management needed by an aging U.S. population. There are so many factors that will assure this is a booming market (both private pay and third-party pay, by the way).

We have an aging population, with predictions that the 50+ population will live to 110 years of age(!). There is the push by financially destitute Medicaid programs to keep people at home and out of state-paid nursing homes, coupled with the increasing amount of service cost that consumers and families must pay out-of-pocket. New technologies allow more people with greater levels of disability to live at home. And, we have a changing consumer demographic—a soon-to-be-aging baby boomer population that wants to remain home as long as possible.

Behavioral health and social service provider organizations that give up the market for in-home services and supports for an aging population risk losing the in-home market altogether. Integration isn't a phenomenon limited to physician offices.