CAPABLE: A Patient-Directed, Home-Based Program for Older Adults

The Issue  

Central Texas has a rapidly growing population of adults over 65 and half of those households (over 81,000 of them) do not earn enough to make ends meet[1]. For all of us, our health is largely determined by factors outside the clinic walls. Our ability to live in our homes safely and independently is critical to our health. However, remaining in our homes as we age becomes increasingly challenging for older adults with functional limitations and chronic conditions. This impacts the health and well-being of these older adults and creates excess costs for health systems.

In 2021, St. David’s Foundation supported Meals on Wheels and the Area Agency on Aging of the Capital Area in implementing CAPABLE, Community Aging in Place—Advancing Better Living for Elders, in Central Texas. CAPABLE is an innovative patient-directed program which addresses both individual function and overall healthcare expenses. Developed by Johns Hopkins University, the program has been implemented in sites across the country with rigorous evidence of effectiveness. This home-based program brings together an occupational therapist (OT), a registered nurse (RN), and a handy worker to support the older adult participating in CAPABLE in achieving their own goals to improve health, safety, and independence over the course of four to five months.

The Findings  

In the first year of implementation, more than 100 older adults in Central Texas completed the program. In partnership with Johns Hopkins University School of Nursing, the Foundation launched a learning collaborative, technical assistance, and external evaluation to support the sites in implementing the program with fidelity while also adapting it as needed to meet the unique needs and conditions in Central Texas.   

The process and outcomes evaluations show fidelity to the model and improvements in health outcomes consistent with the evidence base. Participant outcomes include:

• Improved performance on vital activities of daily living such as eating, bathing, toileting, dressing, and getting in and out of chairs. Out of eight activities of daily living, participants improved in at least one daily activity and reduced limitations in others. 
• Improved performance on additional activities of daily living such as preparing meals, doing dishes, shopping, using phones, doing laundry, and taking medications.  
• Reduced depressive symptoms with an average reduction of at least 20% across sites.  
• Improved self-confidence in avoiding falls and reduced level of worry by at least 25%.  

The evidence of effectiveness in Central Texas builds the case for patient-centered models that improve health and well–being outside of the clinic. The process evaluation demonstrates fidelity to the model and the replication of the evidence base increases confidence that cost savings found at other sites is consistent in Central Texas. This includes compelling evidence of an average cost savings of $22,120 per CAPABLE participant over a 2-year period[2].  

St. David’s Foundation is committed to sharing what was learned in Central Texas about implementation and effectiveness. For copies of the full Process Evaluation or Outcomes Evaluation, please email [email protected].    

[1] https://www.unitedforalice.org/demographics/texas

[2] Ruiz et al. 2017 https://doi.org/10.1377/hlthaff.2016.1305