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Overview of the CAPABLE Program
CAPABLE addresses both function and cost. CAPABLE is a program developed at the Johns Hopkins School of Nursing for low-income seniors to safely age in place. The approach teams a nurse, an occupational therapist and a handy worker to address both the home environment and uses the strengths of the older adults themselves to improve safety and independence.
CAPABLE Improves Health Outcomes and Lowers Costs1
More Than 6X Return on Investment
Roughly $3,000 in program costs yielded more than $30,000 in savings in medical costs driven by reductions in both inpatient and outpatient expenditures.
Source: Ruiz, S., Snyder, L. P., Rotondo, C., Cross-Barnet, C., Colligan, E. M., & Giuriceo, K. (2017). Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use. Health Affairs,36(3), 425-432. doi:10.1377/hlthaff.2016.1305
Halved Difficulties in Function
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.
Reduced Symptoms of Depression
Symptoms of depression, as well as the ability to grocery shop and manage medications also improved.
Improved Motivation
The change in physical environment further motivates the participant. Addressing both the people and the environment in which they live allows the person to thrive.
1 In the period 2012–15, a demonstration project enrolled 281 adults ages sixty- five and older who were dually eligible for Medicare and Medicaid and who had difficulty performing ADLs. ADLs include eating, bathing, dressing, moving around, transferring and toileting.
CAPABLE Testimonial
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Overview of the Training
The on-line training and home visit simulations taught by JHU professors and clinicians is available so that your organization can provide the CAPABLE program. Two different tracks are offered: one for nurses, the other for Occupational Therapists. The training is supported by additional webinars, office hours, a peer user group, and review of up to 3 work orders.
The target audiences of CAPABLE training include health care systems, accountable care organizations, insurance companies, state/county/city Department of Aging, skilled nursing facilities, nursing homes, home healthcare agencies and non-profits in the healthcare and housing sectors.
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Who We Are
Meet the Investigators
- Sarah L. Szanton, PhD, CRNP, Principal Investigator, JHU School of Nursing
- David Bishai, MD, PhD, JHU Bloomberg School of Public Health
- Cynthia M. Boyd, MD, MPH, JHU Bloomberg School of Public Health
- Laura N. Gitlin, PhD, JHU School of Nursing
- Jack Guralnik, MD, PhD, University of Maryland School of Medicine
- Bruce Leff, MD, JHU School of Medicine
- David Roth, PhD, Center on Aging and Health
- Elizabeth K. Tanner, PhD, RN, JHU School of Nursing
- Roland J. Thorpe, Jr., PhD, JHU Bloomberg School of Public Health
- Jennifer Wolff, PhD, JHU Bloomberg School of Public Health
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Topics Covered
Here are some of the key topics covered in our learning modules
Module O (for both the OT and the RN):
- Background of CAPABLE
- Importance of Physical Function and Home Environment
- Aging with functional Limitations
- Motivational Interviewing
OT Module 1:
- Procedures and Documentation for the first visit
- Building rapport
- Assessing function
- Assisting in selection of goals
- Determining readiness
OT Module 2:
- Administration of home visit 2, which includes:
- Review of first visit
- Conducting a home tour
- Discussion of fall prevention and recovery strategies
- Determine which repairs need to be made
- Identification of modifications, assistive equipment and supplies needed
OT Module 3:
- Conducting 3rd, 4th and 5th home visit, which includes:
- Developing, delivering and modifying the action plans
- Demonstrate and practice strategies
OT Module 4:
- Delivering the final visit, which includes:
- Reviewing goals met/partially met/not met
- Determining a final readiness-to-change scale score
- Review tip booklet
RN Module 1:
- Procedures and Documentation for the first visit
- Building rapport
- Assessing function
- Assisting in selecting goals
- Assess readiness to change score
RN Module 2:
- Administration of home visit 2, which includes:
- Review medication list
- Demonstrate CAPABLE exercises
- Brainstorm and problem solving for target areas
RN Module 3:
- Completing Home Visit 3, which includes:
- Brainstorm strategies
- Action planning
- Evaluate communication between participant and their health care provider
RN Module 4:
- Conducting Home Visit 4
- Complete action plans
- Review accomplishments of program
- Assess readiness to change score
Format
- Self-paced Online Modules, Simulations, Client Videos, and White Boards
If you have any issues accessing the modules and simulations contact us at SON-ExecEd@jhu.edu.
For further information please contact: CAPABLEinfo@jhu.edu