A CAPABLE Program for Aging-in-Place

Q. With a bad back and arthritis in her knees, my 76-year-old mother, Gwen, struggles to walk down the steps outside her home to go out. Afraid of falling, she often opts to stay inside rather than brave the loose railings out front.

Inside, my mom’s home proves a challenge to navigate, as well. Frayed rugs and wayward lamp cords are consistent tripping hazards. And with no grab bars, lowering herself into a bathtub puts more pressure on her weakened knees. Despite these challenges, my mother wants to avoid moving to a retirement home. She feels comfortable in her home and wants to stay as long as she can.

I would like to honor my mother’s wishes and do what I can to help her age-in-place safely, but I don’t know where to start. Are there any programs out there to help people in her situation, and to make her home safer and more livable for someone susceptible to falling? Thanks for your help!

A. Seniors who want to age-in-place are often faced with numerous challenges just getting around their own homes. A program called CAPABLE (Community Aging in Place, Advancing Better Living for Elders) is helping seniors who wish to age-in-place to avoid being injured in their own homes.
The pilot of the CAPABLE senior care program started at Johns Hopkins in 2009, with the focus of improving the home environment—and saving Medicare money in return. The program combines three key elements of senior care services: nursing care, occupational therapy, and home improvement. For every $3,000 cost per person, the program saves Medicare more than $10,000, according to recent results published in Health Affairs.

One of the most surprising aspects of the program has been its ability to show big savings from relatively minor investments, such as better lighting at home, that can help keep seniors out of outpatient and hospital settings.

How to Qualify for the CAPABLE Program

To qualify for the program, low-income seniors must report having trouble with at least one activity of daily living (ADL). Seniors are enrolled in the program for four months and can receive the three services over several visits.

Seniors in the program identify functional goals they’d like to achieve, such as walking up the stairs without pain, taking a shower more easily, or simply being able to leave the house more often. Then, they work with an occupational therapist, nurse, and a handyman, who are hired locally, to help facilitate those goals.

The end goal is to increase participants’ overall quality of life on their own terms, says Sarah Szanton, the creator of CAPABLE and a professor at the Johns Hopkins School of Nursing and the Bloomberg School of Public Health.

How the Program Works

The program consists of 10 home visits — six with an occupational therapist and four with a nurse. Each participant also gets an allotment for home repairs and modifications, provided by Civic Works, a CAPABLE partner.
Up to $1,300 of each person’s allotment can go toward home improvements, such as new banisters, lower kitchen shelving, better lighting and other household items. The average participant’s home usually needs about 16 different changes.

The remaining $1,700 is put toward occupational therapy and nursing services, such as training on assistive devices, special household instructions, or simple motivation and encouragement. “If someone has weak legs and has a hard time getting their foot over the tub, it would be a combination of making the tub easier to get into with grab bars plus strengthening their legs and helping improve their mood,” Szanton explains. “It’s really surprising how much small things can make a big difference.”

How the Program is Funded

The program is funded by a number of grants from the National Institutes of Health (NIH), the Centers for Medicare & Medicaid Services (CMS) and the Robert Wood Johnson Foundation, and run by the Johns Hopkins University School of Nursing. Since its pilot, the program had reached 700 seniors and expanded from Baltimore to Colorado, Michigan, North Carolina, California, Vermont and Pennsylvania.

With a new grant of nearly $3 million from the Rita & Alex Hillman Foundation, Szanton is turning her attention to expanding CAPABLE across the country. Expansion is underway at 26 locations in 12 states, and Medicaid programs in Massachusetts and Michigan have adopted a version of it for some members. A major challenge is securing funding, since public and private insurers don’t typically pay for these kinds of services. So far, foundation and grant funding has been the major source of support.
Szanton is advocating for the program to become a Medicare benefit or part of Medicare Advantage plans. Private home care agencies might also be able to adopt the program for their own needs.

CAPABLE has Produced Some Promising results

The CAPABLE program is a step in the right direction for a senior who values his or her health as well as their independence.
The results so far have been promising:

  • Over the course of five months, participants in the program experienced 30% fewer difficulties with certain activities, according to a clinical trial. Participants had difficulty with an average of 3.9 out of 8.0 Activities of Daily Living (ADLs) at baseline, compared to 2.0 after five months.
  • Depression also markedly improved among seniors who took part in the program. Just over half (52.9%) of the studied seniors reported an improvement of depressive symptoms, the data shows.
  • 82% of participants strongly agree that the program made their life easier and their home safer.
  • Nearly 80% said it enabled them to live at home and increased their confidence in managing daily challenges.
  • Seniors who participate often say they want to cook meals for themselves, make their beds, use the stairs, get out of the house more easily, walk around without pain or go to church.

For more details about the CAPABLE program, please click here.

When Aging-in-Place is no Longer the Best Option

Programs such as CAPABLE are great ways to prolong the amount of time that you can age-in-place. This is important, as most people want to stay in their home for as long as possible. However, if despite therapy and home repairs, you or a loved one cannot live independently and are showing signs that living alone is a strain, it may be time to consider other alternatives.

Whether the outcome is in-home care, assisted living, or nursing home care in the future, it is always wise to plan ahead. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be completely spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Please contact us whenever you’re ready to make an appointment for an initial consultation:

Elder Care Attorney Fairfax: 703-691-1888
Elder Care Attorney Fredericksburg: 540-479-143
Elder Care Attorney Rockville: 301-519-8041
Elder Care Attorney DC: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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