Elders Get a CAPABLE Hand in Shoring Up Home Safety

Jack and Jill, a Mother Goose nursery rhyme

Jack and Jill went up the hill
To fetch a pail of water.
Jack fell down and broke his crown,
And Jill came tumbling after.

CAPABLE, which stands for Community Aging in Place, Advancing Better Living for Elders, is a Baltimore-based project that helps low-income older adults “age in place” with assistance from occupational therapists, nurses and handymen.

The project is being closely watched by Medicaid officials in other states as a way to coordinate care, improve personal function, and avoid pricey and sometimes preventable nursing home admissions. Today, it’s difficult for Medicaid patients to get these services.

With more than $8 million in research money from the National Institutes of Health and the Centers for Medicare and Medicaid Services, the project goes beyond home repair for health. It starts with a full-scale assessment of each participant’s needs. 

The four-month pilot program consists of 10 home visits – six with an occupational therapist and four with a nurse. Each participant also gets $1,100 in home repairs and modifications, provided by Civic Works, a CAPABLE partner.

“What CAPABLE does is decrease that gap between what the person can do and what the environment requires of them,” said Sarah Szanton, a Johns Hopkins University associate nursing professor who leads the project. “Very simple $10, $20, $30 modifications can make a big difference.”

In one home, a Hopkins nurse discovered that an 82-year-old woman was taking all of her 26 daily medications at once instead of staggered throughout the day. That often left her disoriented and sedentary, and she eventually became too weak to get out of bed without help.

First the nurse fixed the medication schedule. Then an occupational therapist taught the woman leg-strengthening exercises and installed $30 steel risers to make it easier for her to get in and out of bed. She soon was moving around on her own.

In another example, 73-year-old Nancy Dessesaure (featured in the video) struggled to walk down the dozen or so steps outside her home to go to church because of the arthritis in her knees and the loose railings on her front porch steps. She was afraid of falling, and that fear extended inside.

Lamp cords and frayed rugs presented tripping hazards, and with no grab bars, lowering herself onto the toilet or into a bathtub put pressure on her weakened knees. Civic Works fixed the railings outside, installed grab bars in her bathroom, tacked wires and cords against baseboards, and taped down the throw rugs to prevent tripping. These simple modifications allowed Dessesaure to stay safely in her own home where she felt comfortable instead of being forced into a traditional retirement home.

What’s unique about this project is the proactive nature of visiting a senior’s home to evaluate their needs and make minor corrections. A visit to the doctor’s office almost never includes a discussion of the home environment and ways to prevent falls or improve wellness. Maybe it’s about time for that. It would help lower the cost of providing care.

The benefits of aging in place

An AARP survey in 2010 found that nearly 90% of seniors wanted to remain in their current home for as long as possible. But the home environment can be as disabling as a disease. Too often older Americans end up in a nursing home not because they’re super-sick but because they can’t get through their days safely at home.

Government figures show nearly 1 in 5 seniors have trouble with at least one activity of daily living, such as walking or bathing. Those physical limitations become more difficult with toilets that are lower than chairs, doorways that are too narrow for walkers, kitchen cabinets that are too high to reach, and counters that are too tall to sit at while cooking. Plus, nearly one-third of older adults fall each year, and most of them are injured inside the home, according to the Centers for Disease Control and Prevention.

Can these home modifications save money?

The four-month CAPABLE intervention costs about $4,000 per participant, including the home modifications and specialists’ salaries, but the average U.S. cost for nursing home care is over $83,000 a year. At that rate, the benefit of keeping seniors safe at home can add up fast, and solutions that support aging-in-place can literally save the family estate.

For families, perhaps the bigger question is how long the solutions will last. Modern Health Talk helps families find technology and home modification solutions and brainstorm options as new challenges crop up.

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