New Home-Based Care Program Reduces Disability and Promotes Aging in Place
September 21, 2016 03:45 PM
A federally-funded home health project in Maryland helped elderly patients with disabilities significantly improve their ability to perform daily activities, reduced depression and enabled them to continue to live in their own homes.
Difficulty performing everyday functions, such as walking, dressing, bathing, and shopping, is a major cost driver that is usually overlooked in traditional medical care. This makes no sense because people with chronic illness and physical limitations are more than four times more likely to be among the top five percent of health care services than the rest of the general public. About $219 billion is spent every year on long-term service for people who cannot function independently.
To address this problem, the Center for Medicare and Medicaid Innovation (CMMI) funded a project in Baltimore to evaluate the Community Aging in Place, Advancing Better Living for Elders (CAPABLE), a program for physically disabled seniors. By the end of the five-month program, 75 percent of participants were able to perform more daily activities than before and their psychological wellness improved markedly, as well.
A team of three – an occupational therapist, registered nurse and a handyman – were assigned to each participant. The therapist made six visits, the nurse made four visits and the handyman spent one full day at the participant’s home doing repairs and installing devices to make life around the house easier.
An interesting focus of the program was rather than telling the seniors what they needed to do, the participants were instead asked what they needed to improve their lives and the team then addressed those needs.
All 234 low-income participants – 83 percent were women and 80 percent were African-American -- had trouble with ordinary tasks, known as activities of daily living (ADL). On average, participants had trouble with about four tasks at the start of the program, but reduced that by half to only two by the end of the program. Depressive symptoms improved in over half of the participants.
“We’re improving people’s lives, improving their abilities,” said Sarah Szanton, a Johns Hopkins University associate nursing professor who led the program.
Of course, when it comes to health care, patient outcome is the most important factor, but the cost cannot be overlooked. The average cost of delivering the program was $2825 per participant. That includes all ten clinician visits, mileage, care coordination, supervision, home repair and modification, and assistive devices.
By comparison, according to federal data, a semi-private room in a nursing home costs an average of $6235 per month. Note that the $2825 cost per participant covers five months.
A version of the CAPABLE program is being studied in Michigan and Szanton would like to see it incorporated into Medicare Advantage plans and Medicaid Waiver programs intended to keep seniors out of nursing homes.