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Community Aging in Place - Advancing Better Living for Elders (CAPABLE)

An Evidence-Based Practice

Description

The CAPABLE program was designed as an extension of the Advancing Better Living for Elders (ABLE) program, which improved the activities of daily living such as bathing, dressing, or walking for older patients. By making improvements to occupational therapy delivery and home modifications specific in increasing independent functional in-home goals, the aging population can sustain individual capacity in the home environment while reducing Medicaid costs.
These interventions reduce health effects of impaired physical function as well as depressive symptom management that dependent living can lead towards.

Goal / Mission

CAPABLE is a 5-month structured home visit program delivered by an occupational therapist (OT), a registered nurse (RN), and a handyman to improve daily function in older adults and to lower the monthly average Medicaid expenditure and likelihood of costly healthcare services.

Impact

This study demonstrates that home visit programs can improve the daily quality of life in aging adults. Additionally, they can lead to a reduction in Medicaid expenditures via lower inpatient costs and lower long-term care costs.

Results / Accomplishments

This study used a single-arm randomized clinical trial with a comparison group (n=2,013) of individuals dually eligible for Medicaid and Medicare matched on geographic, demographic, and healthcare use baseline characteristics to the treatment group (n=204). Over the 5 month program period, participants received up to 6 OT sessions, 4 RN sessions, and $1,300 of home repair, modifications, and assistive devices. Cost components including home visit duration, travel time, mileage, frequency of meetings, visit preparation time, and care coordination were all recorded. Additionally, Medicaid claims data was obtained for both the treatment and comparison groups in order to evaluate total Medicaid expenditures.

The treatment group had a significantly lower probability (43% vs 54%) of having an expenditure for any service type (p<0.05) during the program period. Additionally, total Medicaid monthly expenditures were lower for the treatment group ($867 per month per person) than the comparison group.

About this Promising Practice

Organization(s)
Johns Hopkins School of Nursing
Primary Contact
Sarah Szanton, PhD, ANP, FAAN
Johns Hopkins School of Nursing
525 N Wolfe St. #424
Baltimore, MD, 21205
410-502-2605
sszanto1@jhu.edu
https://nursing.jhu.edu/faculty_research/faculty/f...
Topics
Health / Older Adults
Economy / Housing & Homes
Health / Disabilities
Organization(s)
Johns Hopkins School of Nursing
Date of publication
Mar 2018
Date of implementation
May 2012
Geographic Type
Urban
Location
Baltimore, MD
For more details
https://nursing.jhu.edu/faculty_research/research/...
Target Audience
Adults, Older Adults

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An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.