A program that enables seniors to remain at home, remain functional, and remain safe.
SARAH L. SZANTON, PH.D., ANP, INTRODUCES CAPABLE
Most senior adults prefer to remain in their home as they age. However, their challenges with function – including activities of daily living such as bathing, dressing, and getting in and out of a chair – threaten independence, strain family and care partners, and dramatically increase health care costs.
CAPABLE is a low-cost, comprehensive, participant-drive model that improves function by addressing the home environment and using the strengths of the older adults themselves. It provides five months of in-home support by an occupational therapist, registered nurse and handy worker. The interdisciplinary team uses motivation interviewing, active listening, and coaching communication methods to enable the participate to achieve goals they develop and prioritize themselves.
- Combining environmental and personal supports, older adults can cut their disability in half and decrease depressive symptoms.
- CAPABLE improves health incomes while reducing health care costs. $3,000 in participant program costs has been shown to yield $22,000 in medical savings for dual eligible beneficiaries over two years.
WHERE WE WORK
IMPLEMENTING CAPABLE -+
CAPABLE is currently in 30+ locations across the country. Successful adopters include health systems, housing organizations, and community-based groups. The Johns Hopkins University CAPABLE team helps programs with implementation to keep start-up costs down. License fees include readiness and initial implementation support, online clinician training, and ongoing technical assistance.
- Individualized technical assistance and pre-implementation support
- Self-paced online training modules for clinicians
- Implementation and clinician manuals, sample documents, evaluation guides
- Regularly held office hours for administrators and clinicians
- Sustainability guidance
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 handy worker 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 -+
Maintaining mobility and preventing disability are key to living independently as we age – National Institute on Aging, November 2020
Program Offers TLC To Older Adults And Their Homes So They Can Stay Put – National Public Radio, November 2019
Aging-in-Place Program from Johns Hopkins on the Verge of ‘Exponential Growth’ – Home Health Care News, August 2019
Click here for the CAPABLE website.
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.
Contact us to learn more about this solution and how it can benefit your organization.