Title: Community Aging in Place, Advancing Better Living for Elders (CAPABLE)
Organization: Johns Hopkins University School of Nursing
Innovation Type: Community Based Disease Management
What They’re Doing: Home-based intervention to increase mobility, functionality, and capacity to "age in place" for low-income adults with age-related chronic disease
Clinical Innovation: CAPABLE is a community based program to enhance the lives of elders while averting health care costs. CAPABLE is organized around older adults’ own functional goals and tackles both the person and the home environment to improve wellbeing and function. Participants in the program receive up to 4 visits from a Registered nurse (RN) and 6 from an occupational therapist (OT), and some home repairs from the study handyman. Under the client’s direction, the RN assists participants with medical problems, such as pain and medication management while the OT manages difficulties related to function. Handyman repairs and modifications are prioritized with the participant following a home assessment done by the OT and paid for by the study.
After enrollment, the OT visits the participant and completes an evaluation of current difficulties in performing activities of daily living (ADLs) in their current environment. Both participant and OT then explore equipment, repairs and strategies to enhance safety and function. The OT then orders the necessary equipment and brings in the handyman to begin the modifications. In the subsequent visits, the OT and participant discuss strategies to manage current problems, practicing these strategies and also the use of the new equipment/modifications. These strategies are based on the participants’ goals and include such changes as tightening loose wall to wall carpeting, stabilizing banisters, and providing and training on devices that make dressing and bathing easier to accomplish.
The nursing sessions begin shortly after the OT‘s first visit. The first nursing session is an assessment of participant’s current self management of health care problems and how these problems interfere with everyday life and function. At the end of the assessment, participants identify specific problem areas that they will like to work on with the nurse. During the subsequent visits, the nurse and participant also engage in a brainstorming process to identify strategies that he/she can use to manage the issues identified as problem areas. Typical participant problem areas include pain, mood, strength/balance, and medication management.
Evaluation Type: Experimental
Evaluation Plan: Single-blind randomized controlled trial. There are two CAPABLE programs currently taking place, one funded by the National Institutes of Health and one funded by the Center for Medicare and Medicaid Services. The NIH study is a clinical trial in which participants are randomly assigned to either the control or intervention group after a standard enrollment and data collection visit in which the data collector evaluates their strength, balance, pain, and physical function. Participants in the control receive 10 visits from a research assistant and will engage in sedentary activities of their choice such as scrap booking, playing cards, and listening to music from their childhoods. The control group participants are in the study for the same four months that the CAPABLE group is in. All participants enrolled in the second program, which is funded by the Center for Medicare and Medicaid (CMS) all receive the RN, OT and handyman home visits.
After the participant agrees to enroll in the program, baseline data collection is done. After they receive 4 months of visits, follow up data is collected to assess whether the participants have improved or not. For the NIH trial, there is also data collection one year after baseline to assess long term outcomes. Finally, health care costs are being collected for all participants to determine to what extent CAPABLE saves State and Federal funds. Health care cost collected will be compared to the expenses of a comparable group of Medicare beneficiaries.
Outcomes: Health care cost and expenditures that will be measured and will be based on Medicare and Medicaid records. These include cost of hospitalizations, ambulance transfers, prescriptions (medications and durable medical home equipment), nursing home and rehabilitation facility admissions, home health services etc.
Szanton, S, L., Thorpe, R. J., Boyd, C., Tanner, E.L., Leff, N., Agree, E… Gitlin, L.N. (2011). Community Aging in Place, Advancing Better Living for Elders: A Bio-Behavioral-Environmental Intervention to Improve Function and Health-Related Quality of Life in Disabled Older Adults. Journal of the American Geriatrics Society. 59: 2314-2320.
Pho, A, T., Tanner, E, K., Roth, J., Greeley, M, E., Dorsey, C, D., Szanton, S, L. (2012).
Nursing Strategies for Promoting and Maintaining Function among Community-Living Older Adults: The CAPABLE Intervention. Geriatric Nursing. 33(6): 439-445
Target Population: Elders age 65 and older that have difficulty with at least one ADL (bathing, dressing, etc.) or two IADLs (eating, cooking, etc.), have low monthly income, and are not currently receiving home nursing or therapy.
Date of Implementation: 2012-2015
Sarah L. Szanton, PhD, CRNP, Associate Professor, Johns Hopkins School of Nursing
Where to learn more:
Washington Post article on CAPABLE