VA Healthcare-VISN 4
SAGE QUERI Mobility -- CAPABLE
“Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters.” – IHI Age-Friendly Health System
CAPABLE is a program originally developed at the Johns Hopkins School of Nursing for low-income seniors to safely age in place. The CAPALE team is comprised of an occupational therapist (OT), a nurse (RN), and a handy worker. The intervention is guided by the goals of the senior regarding their functional capabilities in their home environment. While the home environment is modified to facilitate independence and safety, the senior is also gaining confidence in their abilities and knowledge regarding in-home safety.
One of the strongest predictors of hospitalization and nursing home placement is functional disability. However, there are substantial CAPABLE provides an opportunity for to provide for Veterans to receive low-cost, in-home, evidence-based services that improve the ability of disabled Veterans that will enable them to remain in their homes and safely age in place.
Implementing CAPABLE is associated with into practice can be expected to an increased independence performing in activities of daily living (ADL) and/or instrumental activities of daily living (IADL) and decreased decrease hospital and nursing home use over time.
The CAPABLE intervention is a patient-centered, evidence-based approach to identifying and facilitating the functional goals of low-income older adults with deficiencies in 1 Activity of Daily Living (ADL, such as bathing,) or 2 or more instrumental Activities of Daily Living (IADLs), such as putting away groceries and preparing meals.
In up to 6 home visits lasting 1 hour or less over 5 months, an occupational therapist (OT) works with the older adult to identify up to 3 personal goals related to aging in place (e.g., being able to prepare a meal or bathe independently). The OT The OT then provides an environmental home assessment to determine what needs to be addressed to achieve these goals (e.g., removing throw rugs, installing grab bars). The OT also works with the Veteran to meet their goals and improve confidence self-efficacy and confidence completing the goals, using strategies such as simplifying tasks and the home environment, and using assistive devices, while also providing balance and fall recovery techniques. OT interventions provided will empower older Veterans to adapt to future health or mobility challenges. to empower older Veterans to adapt to future health or mobility challenges.
In 4 or fewer home visits lasting 1 hour or less, a registered nurse (RN) similarly assesses the functional goals of the older adult in the domains of pain, depression, strength and balance, medication management (including side effect review), and ability to communicate with a primary care provider. A handyperson handy worker then addresses OT findings by providing minor home repairs and/or making minor home modifications (e.g., installing grab bars, raised toilet seats) over a single day.
In the VA, CAPABLE also provides an opportunity for a more thorough environmental assessment of the home where additional areas for improvement – e.g., critical home repair, can be identified and addressed with accompanying VA programs.
A randomized control trial (n RCT) examining CAPABLE in 300 older adults demonstrated a 30% reduction in difficulty performing ADLs. In a demonstration project, the mean number of ADL deficiencies in participants fell from 4 to 2.
Additional data suggests CAPABLE reduces falls and hospitalizations and reduces costs, compared to a matched Medicare and Medicaid cohort. Although it has not be implemented in the VA setting, CAPABLE has already been disseminated outside the original population, is being paid for by Medicare Advantage (Part C) plans, and was unanimously recommended by the Payment Model Technical Advisory Committee to be reimbursed by traditional Medicare.
FIND OUT MORE ABOUT CAPABLE
Visit the CAPABLE website for more information and resources:
Follow this link to see CAPABLE’s frequently asked questions:
An article describing CAPABLE in OT Practice Magazine:
Mrs. B’s Story: A video on the process and positive effects of CAPABLE: