There are alternatives to nursing homes for frail older people, even for those with long-term health problems. They just need help to convert ‘disability’ into ‘capability’.
For instance, a handyman who repairs an unsteady banister could contribute a great deal in allowing an older frail person to remain in their own home rather than having to go into a nursing home, the same as visits from occupational health therapists or a nurse, who could assist the elderly with their often complex medication regimen and make it easier for them to get around their house and neighborhood. These are just a few simple and inexpensive possibilities that could make all the difference for thousands of seniors between having to go to a nursing home or being allowed to remain in their home. However, in reality, these services are often unobtainable for those who need them most, i.e. the poorest and sickest older people on Medicare and Medicaid.
A new initiative called ‘Community Aging in Place, Advancing Better Living for Elders’ (CAPABLE) and a $4 million Health Care Innovation Award from the American Department of Health and Human Services Center for Medicare and Medicaid are now aiming to make these services available. This new, unique health care program, which is lead by assistant professor Sarah L. Szanton, PhD, CRNP from the Hopkins University School of Nursing, can help numerous senior citizens to remain in their own homes, saving millions of dollars of taxpayers money.
Szanton’s project was the only award made to a nursing school that was chosen from more than 3,000 submissions. It is an inexpensive program that can enable elderly people at risk to avoid sustaining fractures through falls, visits to the emergency room because of taking the wrong medication and being hospitalized because of poor nutrition and diet. With the award, Szanton will be able to demonstrate how CAPABLE, which is built on solid base of evidence, can positively influence the health of 500 elderly at-risk people in Baltimore who are on Medicare and Medicaid by making a small investment in form of a nurse, an occupational therapist and a handyman, whilst simultaneously lowering their health care costs.
Szanton comments:
“It isn’t rocket science. Simply put, how you are able to live affects where you live. For older adults, living in poverty and a sub-par environment with chronic illness too often and too quickly leads to nursing home placement. CAPABLE could help change that future to one of dignity and better health at home, not in a home.”
Szanton will implement and evaluate the CAPABLE program over the next three years as a model for other communities. Even though the services can be obtained under the Medicaid program’s Home- and Community-Based Services waiver, the services that CAPABLE offers are generally not provided in a coordinated manner and it is this coordination, which integrates the services of a registered nurse, an occupational therapist and a handyman that will provide frail, elderly people with an individually tailored in-home service.
The team will help to improve participants’ abilities and their physical environment in up to 10 home-based sessions over a 16-week duration so that they can remain in their own homes. The handyman may repair unsafe fixtures or undertake improvements like installing grab bars, whilst the occupational therapist can train people to help avoid falls by improving their balance, and a nurse may implement simple strategies to help remember medication regimes.
Szanton explains:
“Independence and the ability to act freely are basic to the American spirit, but chronic, age-related illnesses like stroke, heart disease, arthritis, and diabetes can get in the way. And while our health care system manages illnesses, it doesn’t address their effect on mobility and ability. That’s what CAPABLE is all about. It confronts the actual problem of staying in the home: can people function? Can they bathe and dress? Can they stand long enough to prepare food? And then, the CAPABLE program provides individualized care to the people themselves and to their homes to support independence.”
By winning the award, Szanton has shown that CAPABLE can improve care and also help save precious federal and state Medicaid and Medicare expenditure. According to Szanton’s estimates, the $4 million grant will incur savings in height of $6 million in reduced hospitalizations and nursing home admissions. That amounts to a net saving of $2 million over the three-year grant period, which is 25% less in hospitalizations and 40% less in nursing home placements for 500 program participants.
The overall cost for the 16-week program, including labor and supplies, is approximately $3,000 per participant, which is in no relation to the annual cost of $75,000-$100,000 for staying in a nursing home.
Szanton concludes: “This means the program would begin saving federal and state Medicare and Medicaid dollars if it resulted delayed nursing home entry among participants by just two weeks. Imagine the savings, and the exponential growth in human dignity, possible by helping elders around the country to remain able through CAPABLE.”
Written by Petra Rattue