CAPABLE program can help countless older adults avoid nursing home stays

Nursing homes do not have to be inevitable destinations for frail older adults. Many—even those with long-term health problems—can remain at home and be independent. All it takes is a little help to change "disability" to "capability".

A handyman with a few nails to fix a wobbly bannister can make the difference between staying at home and a nursing home stay. Visits from a nurse or occupational therapist can help simplify a bewildering medication regimen or improve the ability to get around the house and neighborhood. Simple, inexpensive steps may change the equation for thousands of seniors, but in reality, services like these are rarely available for many at greatest need—the poorest and sickest older adults receiving Medicare and Medicaid.

CAPABLE, short for "Community Aging in Place, Advancing Better Living for Elders," and a $4 million Health Care Innovation Award from the U.S. Department of Health and Human Services Center for Medicare and Medicaid Services, is about to change that reality. Led by Johns Hopkins University School of Nursing assistant professor Sarah L. Szanton, PhD, CRNP, the unique health care program can help countless older adults avoid nursing home stays while saving millions in taxpayer dollars.

Selected from over 3,000 submissions for the awards, Szanton's project—the only award made to a nursing school—is a low-cost program that can help at-risk older adults avoid broken bones from falls, emergency room trips from medication mistakes, and hospitalizations from poor diet and nutrition. Through the award funding, Szanton will demonstrate how with a small investment in a nurse, occupational therapist and handyman, CAPABLE can both make a positive difference in the health of 500 at-risk older Baltimore, MD adults on Medicare and Medicaid and at the same time lower their health care costs.

Szanton notes, "It isn't rocket science. Simply put, how you are able to live affects where you live. For older adults, living in poverty and a sub-par environment with chronic illness too often and too quickly leads to nursing home placement. CAPABLE could help change that future to one of dignity and better health at home, not in a home."

Over the next three years, she will implement and evaluate the CAPABLE program as a model for communities everywhere. While available under the Medicaid program's Home- and Community-Based Services waiver, the services offered through CAPABLE are generally not provided in a coordinated manner. But coordination is the essence of the CAPABLE team that integrates the services of the registered nurse, occupational therapist and handyman, all of whom will provide individually tailored in-home services to these frail, elderly adults. In up to 10 home-based sessions over 16 weeks, the team will help improve participants' abilities and the physical environment, enabling them to remain at home. The handyman might patch holes in floors or add a bathroom grab bar. An occupational therapist may train a participant in better balance to help avoid falls. And a nurse might provide simple strategies to remember how and when to take medications.

Szanton notes, "Independence and the ability to act freely are basic to the American spirit, but chronic, age-related illnesses like stroke, heart disease, arthritis, and diabetes can get in the way. And while our health care system manages illnesses, it doesn't address their effect on mobility and ability. That's what CAPABLE is all about. It confronts the actual problem of staying in the home: can people function? Can they bathe and dress? Can they stand long enough to prepare food? And then, the CAPABLE program provides individualized care to the people themselves and to their homes to support independence."

In her successful award application, Szanton demonstrated that CAPABLE—which is built on a strong research base—not only can improve care, but also can help save precious federal and state Medicaid and Medicare dollars. Szanton projects the $4 million grant will affect a savings of $6 million in reduced hospitalizations and nursing home admissions, a net savings of $2 million over the three-year grant period. That translates to a 25% reduction in hospitalizations and a 40% drop in nursing home placements among the 500 program participants.

In all, the cost of the 16-week program, including labor and supplies, is around $3,000 per participant. That's small change compared with the $75,000-$100,000 annual cost of a nursing home stay. According to Szanton, "This means the program would begin saving federal and state Medicare and Medicaid dollars if it resulted delayed nursing home entry among participants by just two weeks. Imagine the savings, and the exponential growth in human dignity, possible by helping elders around the country to remain able through CAPABLE."