Community Aging in Place: Advancing Better Living for Elders (CAPABLE)
Background & Goal
Older adults’ independence and health is often compromised by chronic, age-related illnesses such as stroke, heart disease, arthritis and diabetes. The inability of older adults to successfully manage every-day life functions such as bathing, dressing, preparing food and taking medications increases the likelihood of their admission into expensive nursing homes. This is true despite research which confirms older adults are both healthier and happier when they are able to remain in their own homes.
Sarah Szanton, PhD, ANP, FAAN, working collaborating across disciplines with Laura Gitlin, PhD, designed an intervention, Community Aging in Place: Advancing Better Living for Elders (CAPABLE), to assist older adults in acquiring the skills, strength and necessary home modifications they need to support their independence.
CAPABLE is a nurse-designed multidisciplinary (nursing, occupational therapy and handyman) intervention developed and tested to reduce health disparities among older adults and aimed at helping older adults “age in place.” By decreasing disability and improving physical function and self-care skills, Dr. Szanton and her colleagues reduce admissions to hospitals and nursing homes which would otherwise result from fall fractures, incorrect medication dosing and poor nutrition and diet.
Always proceeding from the vantage point of the older adult, CAPABLE’s nurse and occupational therapist assess each older adult’s mind, body and spirit to arrive at the goals which will enable that individual to age comfortably at home. This personalized and convenient intervention, conducted in the participants’ homes, is guided by the Society to Cells Resilience framework published by Dr. Szanton and her colleague, Dr. Gill, in Advances in Nursing Science which posits that all humans are resilient at any age and are composed of multiple overlapping resilient systems.
Evidence of Success
In a population of low-income older adults on Medicaid and Medicare who participated in CAPABLE, 75% of participants improved their self-care over the course of five months, with the average CAPABLE participant cutting in half their disability (defined as the number of self-care tasks that are difficult to achieve). CAPABLE participants also experienced a decrease in their depressive symptoms similar to that of an anti-depressant medicine.
Comparing the health care cost expended for participants in CAPABLE to the health care cost for a non-participating group, CAPABLE saved, on average, $2,765 per quarter - or more than $10,000 per year – for Medicare for at least two years. Inclusive of all patient visits and home repairs and modifications, CAPABLE cost only $2,825 per year, with decreases in both inpatient and outpatient costs, fewer readmissions and fewer observation status stays.
CAPABLE is currently implemented in thirteen cities in eight states (including two rural areas) within a variety of policy settings from two Accountable Care Organizations, one hospital readmission project, a state Medicaid waiver of Home and Community Based Services, as well as in some free standing clinics.