A program that enables seniors to remain at home, remain functional, and remain safe.
SARAH L. SZANTON, PH.D., ANP, INTRODUCES
Most senior adults prefer to remain in their home as they age. However, their inability to take care of their basic needs like preparing their own meals or going to the bathroom or dressing themselves often means admission to a long-term care facility, which compromises the individual’s dignity and costs them, or taxpayers, thousands of dollars a month.
Community Aging in Place—Advancing Better Living for Elders (CAPABLE) is a low-cost program that integrates a registered nurse an occupational therapist and a licensed handyman who work with individual seniors—particularly low-income urban men and women of color—to keep them at home, functional and safe.
- Combining environmental and personal supports, older adults can cut their disability in half and decrease depressive symptoms by as much as an antidepressant would.
- Results from a demonstration project during 2012-15 showed a 3x Return on Investment, a 2x Improvement in Functionality and symptoms of depression and the ability to shop and manage medications also improved.
The goal of CAPABLE is to build a culture of health, which means developing multiple layers of resilient possibilities so that each person’s cells, organs, families, communities, and society are able to respond to stressors, challenges, and opportunities with resilient potential.
CAPABLE could be offered nationally to all Medicaid recipients under a provision of the Affordable Care Act in which any pilot program shown to save Medicaid costs is adopted as federal policy.
CAPABLE costs approximately $3,300 per participant for four months including up to $1,200 in home repairs.
The CAPABLE Workshop
Workshops to train individuals who want to implement CAPABLE are held quarterly at Johns Hopkins, in Baltimore or by special arrangement at your institution. The Workshop includes:
- e-learning modules for OTs and RNs
- Training materials
- Follow-up telephone support
About Sarah L. Szanton, Ph.D., A.N.P.
While making house calls as a nurse practitioner to homebound, low-income older adults in West Baltimore, Sarah noticed that their environmental challenges were often as pressing as their health challenges. This inspired her to explore ways to make it possible for low-income older adults to live in their own homes for a longer period of time.
Her “aha” moment came when she realized the potential impact home maintenance could have on health. Sarah developed the Community Aging in Place—Advancing Better Living for Elders (CAPABLE) that combines handyman services with nursing and occupational therapy to improve mobility, reduce stress, and decrease health care costs.
When she’s not investigating ways to help older adults “age in place”, Sarah mentors and teaches future nurse researchers as a professor and the director of the doctoral program at the Johns Hopkins School of Nursing.
What study participants told us
“You gave me my independence back. I no longer have to ask permission to take a bath or have the army help me get out on my front porch. I can do it myself which makes me feel like a grown up again! It’s better than winning the lottery!” (74-year-old)
“This has been opening my mind up to new ideas and has made me think more about creative solutions. My daughter told me last year that I was useless and I almost believed her. But now I know I’m not—I’m capable!” (71-year-old)
“I know I am an old man. Before, my wife had to help me to get up in the morning and to get out of the bed. Now I can get up on my own and go. I now need to hustle back home to meet you.” (78-year-old)
MEDIA COVERAGE -+
Innovative Model Focused on Function of Older Adults Shows Promise for Improving Lives and Reducing Healthcare Costs: Preliminary Findings from CAPABLE – Blog post, Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins School of Public Health, February 13, 2015
CAPABLE program team helps Baltimore’s elderly stay in homes Johns Hopkins Magazine, Summer 2014
CAPABLE Empowers Aging in Place Universal Design News, January 2014
Program helps seniors stay in homes longer WBALTV, October 2013
Elders Get a CAPABLE Hand in Shoring Up Home Safety PBS News Hour, August 2013
Program hopes to accommodate “demographic tsunami” of seniors CBS News, September 2013
The Public Health Crisis that Overwhelms Families: One Family’s Caregiving Story RWJF Culture of Health Blog, November 2011
Published papers and chapters on CAPABLE
- *Szanton, S.L Leff, B.L., Wollf, J.L., Roberts, L. Gitlin, L.N Home-based care model reduces disability and promotes aging in place in press at Health Affairs
- Szanton, S.L. Aging in Place: Innovative Teams (2017 publication date) chapter in Using Nursing Research to Shape Health Policy: Springer Publishers. Edited by Patricia Grady and Ada Sue Hinshaw
- *Szanton, S.L. Thorpe, R.J., Boyd, C., Tanner, E.K., Leff, B., Agree, E., Xue, Q.L., Allen, J.K., Weiss, C., Seplaki, C.L., Guralnik, J.M., Gitlin, L.N. (2011). CAPABLE: A bio-behavioral-environmental intervention to improve function and health-related quality of life of disabled, older adults. Journal of the American Geriatrics Society, 59(12): 2314-2320. PMCID: PMC3245364
- Pho, A. Tanner. E.K., Roth, J., Greeley, M., Dorsey, C., Szanton, S.L. (2012) Nursing Strategies for Promoting and Maintaining Function among Community-Living Older Adults: The CAPABLE Intervention. Geriatric Nursing. Nov-Dec; 33(6)439-45 (with Master’s student)
- Gitlin, L.N., Szanton, S.L., Hodgson, N. (2014) It’s Complicated – But Doable: The Right Supports Can Enable Elders With Complex Conditions To Successfully Age In Community. 37 (4): 51-61
- Szanton, S.L. Klimmek, R. Roth, J., Savage, J., Nkimbeng, M. (2014) Improving unsafe environments to support aging independence with limited resources. Invited manuscript for Nursing Clinics of North America issue: Facilitating Aging in Place: Safe, Sound, and Socially Secure.49 (2) 133-145 PMCID: PMC4074077
- Szanton, S.L., Wolff, J.W., Leff, B.L., Thorpe, R.J., Tanner, E.K., Boyd, C., Xue, Q., Guralnik, J. Bishai, D. Gitlin, L.N., (2014) CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design. Contemporary Clinical Trials 38(1):102-112. PMCID: PMC4074085.
- *Szanton, S.L., Wolff, J.W., Roberts, L. Leff, B.L., Thorpe, R.J., Tanner, E.K., Boyd, C., Xue, Q., Guralnik, J. Bishai, D. Gitlin, L.N. (2015) Preliminary data from CAPABLE, a patient directed, team-based intervention to improve physical function and decrease nursing home utilization: the first 100 completers of a CMS Innovations Project Journal of the American Geriatrics Society 63(2):371-374. PMCID: PMC4498670
- *Smith, P.D., Boyd, C., Bellantoni, J., Roth, J., Becker, K., Savage, J., Nkimbeng, M. Szanton, S.L., (2016) Communication between primary care providers and nurses within the home: an analysis of process data from CAPABLE Journal of Clinical Nursing (with a doctoral student)25(3-4) 454-462. PMCID: PMC4738578
- Szanton, S.L., Gitlin, L.N., Meeting the demographic and health care financing imperatives through focusing on function: the CAPABLE studies Public Policy and Aging Report 16
- Gitlin, L.N., Szanton, S.L., DuGoff, H. (2011). Supporting Individuals with Disability Across the Lifespan at Home: Social Services, Technologies, and the Built Environment. “White paper” commissioned by the SCAN Foundation.
- Bridges, A., Szanton, S.L., Evelyn-Gustave, A., Smith, F. Gitlin, L. Home Sweet Home: Interprofessional Team Helps Older Adults Age in Place Safely. OT Practice9.13
- *Gleason, K. Tanner, EK, Boyd, C.M., Saczynski, J.S., Szanton, S.L. (2016) Factors Associated with Patient Activation in an Older Adult Population with Functional Limitations online ahead of print at Patient Education and Counseling (with PhD student) PMCID: 772754
- Smith, P.D., Becker, K.L., Roberts, L., Walker, J.L., Szanton, S.L. Associations among pain, depression, and functional limitation in low-income, home-dwelling older adults: an analysis of baseline data from CAPABLE. in press at Geriatric Nursing (with nursing student and post-doc)
WHY CHOOSE A JOHNS HOPKINS SOLUTION?
For 130 years, Johns Hopkins Hospital has led the way in both biomedical discovery and health care, establishing the standard by which others follow and build upon. This is one of many faculty-developed programs, protocols and services provided by Johns Hopkins HealthCare Solutions to improve health outcomes and reduce the cost of care.
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