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Aging with Independence

Kaiser Health News recently published a story, Frail Seniors Find Ways to Live Independently which detailed the positive impact of a program for frail low-income seniors called: “Community Aging in Place - Advancing Better Living for Elders” (CAPABLE). According to a study of the program by the Journal of the American Medical Association (JAMA) Internal Medicine, over the course of five months, participants in the program experienced 30 percent fewer difficulties with activities of daily living, such as taking a shower, getting dressed, transferring in and out of bed, using the toilet or ambulating. As noted by John Haaga, the director of the Division of Behavioral and Social Research at the National Institute on Aging, which funded the research, “If someone found a drug that reduced disability in older adults by 30 percent, we’d be hearing about it on TV constantly.”

In the randomized clinical study, half of the adults in the program received the CAPABLE intervention - which included six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1300 - realized significant benefits that enabled the participants to remain at home and increase their confidence in managing daily challenges. The success of the program is attributed at least in part due to the fact it focuses on what people want. According to Sarah Szanton, who developed CAPABLE and directs the Center for Innovative Care in Aging at the Johns Hopkins School of Nursing, instead of telling older adults what’s wrong with them (a common characteristic in medical care), CAPABLE staff asks older adults what they would like to be able to do, but can’t do right now. This helps to identify what is important to someone which increases the likelihood that they will be motivated to get better.

CAPABLE is also proving to be very cost-effective. For every dollar spent on CAPABLE, nearly $10 in combined savings accrues to Medicare and Medicaid. This is primarily due to the hospitalizations and nursing home placements that are prevented. As the program becomes more widely available - it’s currently available in 12 states (including Michigan) - it is hoped that additional funding will be possible as well as adoption of the program by Medicare Advantage plans and traditional Medicare. As noted by Dr. Kenneth Covinsky, a professor of geriatrics at the University of California-San Francisco, “Referring patients to a program like CAPABLE is something that could make a big difference.” Let’s hope so.

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