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

Description

CAPABLE (Community Aging in Place—Advancing Better Living for Elders) is a five-month home-based intervention that helps low-income seniors age in place.

This program was developed by the Johns Hopkins School of Nursing. There are currently over 35 CAPABLE sites across the country, 11 of which are in rural communities. Massachusetts offers the CAPABLE program through its Medicaid program. Colorado is conducting a pilot (to be completed 2024) for Medicaid members, and Connecticut is in the process of rolling out CAPABLE under Medicaid.

The rural sites are located in the following states:

• California
• Colorado
• Iowa
• Maine
• Maryland
• New York
• Pennsylvania
• Texas
• Washington

Services offered

For five months, each CAPABLE participant works with:

• A registered nurse (RN), who visits 3 to 4 times
• An occupational therapist (OT), who visits 4 to 6 times
• Home repair services, which has a budget of $1,300 to make repairs and install safety features

These visits are client-driven. Instead of the CAPABLE staff deciding what the client needs to do, they use motivational interviewing to help participants set their own goals. For example, if the participant wants to bathe safely, the RN might partner with the client to identify issues that affect balance, like overmedication; the OT could teach ways to enter/exit the tub safely; and home repair technicians could install safety features like handrails and nonslip treads. Through this brainstorming process, participants also develop self-efficacy skills to face any challenges that arise after CAPABLE program visits have ended.

Results

The CAPABLE National Center reports a return on investment of over 6 to 1, with over $30,000 in medical costs saved for every $3,000 invested in the program. Participants nationwide have shown reduced symptoms of depression and improved functionality. There are publications about CAPABLE, but there have not been any rural-focused studies published.

For more information about how CAPABLE worked in rural Hawaii and Maine, please read the 2019 Rural Monitor article National Program Helps Older Adults in Rural Maine and Hawaii Feel More CAPABLE.

A review of six CAPABLE studies was published in the Journal of the American Geriatrics Society. Some sites featured in the studies served rural clients:

Szanton, S.L., Leff, B., Li, Q., Breysse, J., Spoelstra, S., Kell, J., ... & Gitlin, L.N. (2021). CAPABLE Program Improves Disability in Multiple Randomized Trials. Journal of the American Geriatrics Society, 69(12), 3631-3640. Article Abstract

Challenges

Finding funding sources and sustaining a program after a grant has ended can be difficult for rural sites. RHIhub offers a list of funding opportunities, which can be narrowed down by topic and state, as well as A Guide to Working with Rural Philanthropy, which provides advice to help rural organizations build relationships with philanthropies.

A nursing shortage may be a challenge in some locations.

Replication

While aspects like the OT and RN are needed to count as a CAPABLE program, national model coordinators can work with rural sites to help them adapt the program to fit their community and clients. For example, the site that used to be in Bath, Maine, used a different grading scale, the Patient-Specific Functional Scale, to help clients rate their goals throughout the five months of the program. In addition, this site also offers safety checks like testing or replacing smoke alarms.

The RN and OT each complete five 60-minute online learning modules, up to 8 hours of live online training, and five webinars or coaching calls. The CAPABLE FAQs section has more information about training, costs, and program support.

Contact Information

Sarah Szanton, PhD, RN, FAAN, Professor
Johns Hopkins School of Nursing
CAPABLE National Center
CapableInfo@capablenationalcenter.org