In our technology-driven society, it seems we tend to rely too much on professional health care providers, nursing homes, and digital solutions to solve all of our health care problems – an observation that seems especially true when it comes to senior care. But often the best ideas for healthy aging appear to come, not in the hospital, but in the home. A recent article we discovered on the Kaiser Health News website provides a perfect example.
CAPABLE: Patient-Centered, Common-Sense, Highly Effective
The Kaiser article by author Judith Graham describes a groundbreaking program out of Johns Hopkins University called CAPABLE. That’s an acronym for the full title, which is a mouthful: “Community Aging in Place — Advancing Better Living for Elders.” Whatever else you call it, CAPABLE is a program, first tested in Baltimore and now available at 26 sites in 12 states, in which low-cost, common sense ideas are being applied to the challenge of helping low-income seniors age safely in their own homes. Best of all, this patient-centered and relatively simple approach works. As Judith Graham writes, “New research shows that CAPABLE provides considerable help to vulnerable seniors who have trouble with ‘activities of daily living’ — taking a shower or a bath, getting dressed, transferring in and out of bed, using the toilet or moving around easily at home. Over the course of five months, participants in the program experienced 30 percent fewer difficulties with such activities, according to a randomized clinical trial — the gold standard of research.” Those results were recently published in the professional journal JAMA Internal Medicine.
As one researcher commented, “If someone found a drug that reduced disability in older adults by 30 percent, we’d be hearing about it on TV constantly.” But CAPABLE isn’t about expensive drugs or technology. It’s about providing low-cost solutions to basic problems faced by low-income seniors. The first CAPABLE study involved 300 adults with an average age of 75, all considered either poor or near-poor. About 90 percent were women and the majority were African American. Members of the study group suffered from multiple chronic medical conditions such as heart disease, arthritis and COPD. In other words, this group included many of the seniors who the health care community finds the hardest and most expensive to treat.
CAPABLE Includes Basic Health and Home Services
Kaiser Health News describes what happened next. “Half of the older adults in the trial received the CAPABLE intervention, which includes six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1,300” involving things like building ramps and installing grab bars. The control group, by contrast, received 10 visits of equal length from a research assistant, not a medical professional, and were encouraged during and after the visit to “use the internet, listen to music, play board games or reminisce about the past, among other activities.” They did not receive home repairs or modifications. After five months of study, both groups had experienced health improvements, but it quickly became clear that those receiving the CAPABLE intervention did much better. Over 80 percent of participants felt strongly that the program had made their life easier and their home safer, allowing them to live at home with greater confidence, better able to manage daily challenges.
We visited the CAPABLE program website (part of the website of the Johns Hopkins School of Nursing). The people running CAPABLE describe it as “a client-centered home-based intervention” designed to help older adults “increase mobility, functionality, and capacity.” The core services of the program involve an occupational therapist, a nurse, and a handyman, with each service working in tandem with the others so seniors can function safely and effectively at home. By improving “problem-solving ability, strength, balance, nutrition, and home safety, while decreasing isolation, depression, and fall risk,” CAPABLE is intended to keep seniors from having to move into expensive government-funded care facilities. According to the program website, “CAPABLE is unique because it is patient-centric. Success is defined by the patient and measured by a nursing/occupational therapist team. The patient decides on functional goals, such as taking a bath or walking to church, as opposed to medical ones, such as reducing blood sugar or blood pressure level.” As the website says, “In today’s health care environment, improving health largely falls outside of health care facilities. Home is where health is.” We concur wholeheartedly.
CAPABLE Saves $10 for Each Dollar Spent
As Kaiser Health News reports, CAPABLE not only benefits seniors, but “It also turns out to be a cost-effective investment. For every dollar spent on CAPABLE, nearly $10 in combined savings accrues to Medicare and Medicaid, largely because of hospitalizations and nursing home placements that are prevented.” The average cost for a senior to go through the CAPABLE program is $2,825 – far less than half the monthly cost of the average room in a nursing home. So far, driven by that kind of ROI, both Michigan and Massachusetts have adopted a version of the CAPABLE program for some residents. So far, however, foundations and grants have funded most of the work since federal Medicare and Medicaid plans have been slow to adopt the initiative. Efforts are underway to persuade Medicare Advantage insurers to fund CAPABLE since new rules have given these firms latitude to offer their policy-holders a wide array of non-medical services.
As we said at the outset of this article, part of the challenge with programs like this involves weaning ourselves off our addiction to technology and returning to simpler, more effective solutions to health care problems. At least one geriatrician agrees. “As clinicians,” he told Kaiser Health News, “when we see older patients with conditions we can’t reverse, we need to understand we haven’t run out of things we can do. Referring patients to a program like CAPABLE is something that could make a big difference.”
Manage Your Health, Manage Your Retirement
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(originally reported at www.khn.org)
