Reviewed by: Matthew Sexton, LCSW
No study measures how older adults find a therapist, but a national survey analysis published in October 2026 found that mental health care use was lower among adults aged 50-64, 65-74 and 75 and older. For licensed therapists, counselors and social workers in private practice who hear from few older clients, the sources point to three routes: video care from home, the aging services network and Medicare, where CMS states that marriage and family therapists and mental health counselors can bill independently effective January 1, 2024.
The evidence is a PLOS Mental Health analysis of the National Health Interview Survey, a Veterans Health Administration study, a Federal Register notice from the Administration for Community Living and a CMS page, all checked in October 2026. They show who uses care less, how one large system reaches older veterans and where federal outreach money goes. They do not show where older adults search or how many are looking in any one town. The next step is to check whether a practice can be reached on the routes these sources name.
Key takeaways
- A national survey analysis of 128,261 adults aged 40 and older found lower mental health care use at ages 50-64, 65-74 and 75 and older.
- In a Veterans Health Administration study, 48.2% of virtual geriatric mental health services were delivered by video to the home.
- The Administration for Community Living is adding $1,084,718 for outreach and training to engage older adults with behavioral health conditions.
- CMS states that marriage and family therapists and mental health counselors can bill Medicare independently, effective January 1, 2024.
Are older adults looking for mental health care at all?
Some are, and national data show that fewer reach care at older ages. The PLOS Mental Health analysis pooled six waves of the National Health Interview Survey, from 2019 to 2024, covering 128,261 adults aged 40 and older. It counted counseling or psychotherapy, mental health medication, or a visit to a mental health specialist within the previous 12 months. About one in five adults in the sample used that kind of care.
The same analysis found use was lower among adults aged 50-64, 65-74 and 75 and older. Use was higher among people with health insurance coverage. The authors call for targeted and culturally responsive strategies to improve equitable access for this ageing population.
The survey does not count searches. It counts care that was received, so it cannot say whether older adults in a given town looked and gave up, or never looked.
Where do older adults reach therapy when they do?
In the Veterans Health Administration, many reach it by video from home. The study of VA Clinical Resource Hubs describes regional telehealth hubs that give veterans geriatric mental health services without long drives to urban centers to find specialists. Clinicians in those hubs completed 9282 encounters with 2013 veterans whose mean age was 75.8.
Most of those services were video to home (48.2%), followed by video to clinic (25.4%) and phone (22%). The authors read this as high acceptability of video-delivered care for older, rural veterans with high care needs.
The study covers one federal health system, not private practice clients. It does not show that older adults avoid video. It shows older veterans using video when specialists are far away.
What is the federal government funding to connect older adults with behavioral health support?
It is funding outreach, training and coordination, not therapy sessions. A Federal Register notice from the Administration for Community Living announces a single-source supplement to the cooperative agreement held by the Lake Erie College of Osteopathic Medicine. The notice states that the FY 2026 supplement is $1,084,718.
The stated purpose is to help the aging and disability network build practical skills and to improve coordination among local aging and behavioral health service providers. The notice is not about search engines or directories. It is about local services working with each other, and a practice can only join that coordination if local aging services know it exists.
Can older adults on Medicare see a counselor or family therapist?
Yes, under the rule CMS describes. The CMS page states that, effective January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare independently for services that diagnose and treat mental illnesses. The same page lists the enrollment criteria for both license types.
The page explains who may bill. It does not promise payment for any given visit, and it does not say whether enrolling fits a practice. That decision belongs to the clinician.
What can a practice do with this evidence?
A practice can make itself reachable on these routes. Offer video sessions and say so plainly. Introduce the practice to local aging services providers. Read the CMS enrollment criteria and decide whether Medicare fits.
A clear directory profile helps an older client or a family member decide whether to call. A profile on Couch Commons carries the clinician’s own bio, focus and way of working, and lists telehealth as a clinician-stated claim, labeled and dated. For the wider picture of where new clients come from, see how therapists get their first clients.
Takeaway
The evidence does not show older adults searching and failing to find a therapist. It shows lower use of care at older ages, video care from home in one large system, and federal money for outreach through the aging network. A practice that wants older clients can be present on those routes.
Frequently asked questions
Does the research show where older adults search for a therapist?
No. None of these sources measures searches, directory visits or AI assistant use by older adults. They measure care received, care delivered by video and federal outreach funding.
Can a mental health counselor see Medicare clients?
CMS states that, effective January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare independently for services that diagnose and treat mental illnesses. The enrollment criteria are on the same page.
Is a low number of inquiries from older adults proof of low demand?
No. Inquiries to one practice are not a measure of demand. The national survey data show lower use of care at older ages, which points to access routes, not to a count of who is looking.
Sources
- Boateng et al., “Mental health care utilization among middle-aged and older U.S. adults: Findings from the National Health Interview Survey,” PLOS Mental Health: https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000744 (checked October 2026)
- Gould et al., “Rural and Non-Rural U.S. Veterans Receiving Virtual Geriatric Mental Health Services in the Clinical Resource Hubs,” Psychiatric Research and Clinical Practice: https://eutils.ncbi.nlm.nih.gov/entrez/eutils/efetch.fcgi?db=pubmed&id=42851643&rettype=abstract&retmode=text (checked October 2026)
- Administration for Community Living, Federal Register notice on outreach to older adults with behavioral health conditions: https://www.govinfo.gov/content/pkg/FR-2026-09-14/pdf/2026-18729.pdf (checked October 2026)
- Centers for Medicare & Medicaid Services, “Marriage and Family Therapists & Mental Health Counselors”: https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/marriage-and-family-therapists-mental-health-counselors (checked October 2026)
This article is general information for clinicians, not legal, billing or clinical advice.
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