Here’s an idea: If you want to know how to help frail older adults age at home, start by asking them what’s important. Then, provide the assistance they need to help them reach their goals. Their challenges, and the solutions to them, are usually pretty straightforward—a grab bar in the shower to prevent falls, good nutrition and medication management, or a bit of physical or occupational therapy to relearn how to safely perform daily tasks. Now, a new study shows that such a program can dramatically improve people’s ability to function at home at a relatively low cost.
The program, called The Community Aging in Place, Advancing Better Living for Elders ( CAPABLE), was developed by Sarah Szanton and her colleagues at the Johns Hopkins School of Nursing. With funding from the federal Medicare and Medicaid programs, Hopkins ran CAPABLE as demonstration from 2012-2015. Nearly 300 older adults participated in the experiment, which provided these services for five months.
Now, in an article published in the journal Health Affairs, Szanton and other researchers from Johns Hopkins reported that the program significantly improved the ability of the participants to manage daily activities such as bathing, getting to the bathroom, eating, and dressing. At the beginning of the program, a typical participant needed help with four personal activities. By the end, she needed help with just two.
The cost of the five-month program? About $2,800 per participant, roughly equal to a week in a nursing home.
The key to the program was a care team that includes a nurse, an occupational therapist, and a handyman. You read that right. A handyman: The guy with the hammer and screwdriver who can install grab bars in mom’s bathroom or tighten up that wobbly railing beside the front walk. Not a medical specialist, who is trained in the latest techniques for treating heart disease or cancer. Not even a primary care physician, though she still plays an important role. A handyman.
It worked like this: First, a registered nurse helped the participant identify her top priorities, such as managing pain, or communicating with a doctor. The occupational therapist helped identify functional goals, such as being able to take a shower. With the help of the handyman, the team took specific steps to help each participant achieve her goals. So, for instance, the occupational therapist may develop exercises to help with balance and the handyman would install those new grab bars.
As any frail older adult or their family caregivers can tell you, the key to staying at home successfully is often the ability to do daily activities without help. An intervention such as CAPABLE that makes it easier can make all the difference.
As the study’s authors say, “The practical effect… can be life changing. For an older person who has difficulty getting out of bed, going to the toilet, getting dressed, and bathing, carrying out these functions with greater ease could enable him or her to continue living at home instead of having to move to an assisted living facility or nursing home.”
The study has its limitations. It did not attempt to determine whether the program reduced nursing home stays or hospital visits. It will also take further research to know about the long-run effects of CAPABLE or how its participants do relative to similar people who were not in the program.
While CAPABLE was tested on a small group of mostly African-American women who lived in Baltimore, it may very well work with a more diverse population. Szanton and her colleagues say that managed care organizations and other medical providers are considering adopting the model.
I’m tempted to ask why it took four Johns Hopkins professors and a PhD candidate to conclude the obvious. But the reality is that few health systems or insurance companies deliver this kind of basic care. So perhaps it does take four professors, a PhD candidate, and a research report in a respected journal to convince insurers and providers to do the right thing.
(Full disclosure: I am an unpaid Trustee of Johns Hopkins Medicine)