Nursing’s CAPABLE Program Helps Older Adults Live Independently

September 19, 2022 by Renee Fischer

New skills, exercises, and house modifications promote safely remaining at home

The idea for CAPABLE emerged in 2009 when Johns Hopkins School of Nursing Dean Sarah Szanton was making house calls as a visiting nurse in West Baltimore and observed that people’s home environments could be just as disabling as their medical conditions.

More than a decade since its pilot study, nearly 5,000 clients have now participated in this free program which stands for Community Aging in Place — Advancing Better Living for Elders.

“It’s important for every person to be able to age with dignity,” says Szanton, who in addition to having a master’s degree in nursing, earned her BSN and PhD from the School of Nursing in 1993 and 2007 respectively. “And philanthropic support has been really important to grow CAPABLE beyond its initial research funding,” she adds, noting the program is currently offered through 45 different sites in 23 states.

Primarily geared for those aged 65 and older, CAPABLE involves six visits with an occupational therapist, four visits with a registered nurse, and minor home modifications and repairs from a handyperson. Staff also assist clients in communication with their primary care providers and provide further referrals if needed. The program is not for those who are terminally ill or in hospice, and clients must be cognitively intact, so that they can participate in the brainstorming and action planning process.

“Everything in CAPABLE is not only client-centered; it is client-directed. It’s very tailored to what they want to work on, and the program lasts approximately four to five months for each person,” says Allyson Evelyn-Gustave, OTR/L, the lead occupational therapist who has also been with CAPABLE since it began.

“Clients self-identify that they’re having difficulty in at least one activity of daily living like walking across a room, bathing themselves, fixing a meal,” Evelyn-Gustave says. “And one of the things we found out in the original research with CAPABLE is that we helped improve people’s moods.”

“They show you love, and they work with you in all aspects of your health, your well-being, everything,” according to Edward Murray, a client who benefited from methods to become more mobile and a reorganization of his kitchen. “I thank God for all of them. It’s really a blessing for people like myself that need the help. Now, I’ve got my willpower back.”

“The nurse helped me with my medications. The therapist helped me with exercises and showed me the right way to do things, to keep me from maybe hurting myself,” says Edith Kerney, a client who had railings installed along her stairways and grab bars in her shower among other things. “All the suggestions that they gave me were wonderful. I did it, and it worked. And I’m just so blessed and grateful,” she says.

Beyond the benefits to each individual, both Szanton and Evelyn-Gustave stress the larger societal impact of CAPABLE.

“It only costs the program about $3,000 a person, but we’ve found through research, it saves about $30,000 in avoided medical costs and nursing home admissions,” says Szanton, who is also the Patricia M. Davidson Health Equity and Social Justice Endowed Professor.

“Given that in the U.S., about 10,000 people are turning 65 every day, and that will be true for about a decade, it’s really important to figure out how older adults can be as independent as possible,” she adds.

“CAPABLE helps overall communities because the older adult is the rock of many neighborhoods,” according to Evelyn-Gustave. “Once they are feeling more confident and more able, folks can volunteer, do work, and help out with their grandchildren.”

“It’s just been an awesome journey. I know we’ve affected so many people’s lives and helped them to age safely in place,” she adds.

Explaining that the program aligns with the School of Nursing’s history of innovation, Szanton states the current plans for CAPABLE are investigating how policy could broaden its reach and how to adapt it for other populations.

“Hopefully, it’ll be baked into Medicare, and all older adults will be able to receive CAPABLE,” according to Szanton.

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Topics: School of Nursing, Promote and Protect Health, Strengthening Partnerships