Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function

TitleDissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function
Publication TypeJournal Article
Year of Publication2019
AuthorsSpoelstra SL, Sikorskii A, Gitlin LN, Schueller M, Kline M, Szanton SL
JournalJournal of the American Geriatrics Society
ISBN Number1532-5415
Accession Number30548594
Keywords*adaptation, *evidence-based model, *Health Services for the Aged, *implementation, *Independent Living, *Medicaid, *Medicaid waiver, *physical function, Activities of Daily Living, Aged, Aged, 80 and over, Female, Geriatric Assessment, Hospitalization/statistics & numerical data, Humans, Male, Michigan, Middle Aged, Patient Satisfaction, Physical Functional Performance, Program Evaluation, United States

BACKGROUND/OBJECTIVES: Of older adults, 42% report problems with daily function, and physical function is the most important consideration for aging individuals. Thus, we implemented a model of care focused on improving physical function and examined health and use outcomes and satisfaction. DESIGN: A 3-year participatory, single-group pretrial/posttrial benchmarked to a usual care cohort that was evaluated prior to the study. SETTING: Four Medicaid home and community-based waiver sites in Michigan. PARTICIPANTS: The participants included 34 clinicians and 270 Medicaid beneficiaries 50 years and older. INTERVENTION: Community Aging in Place, Advancing Better Living for Elders (CAPABLE), an evidence-based model of care that improved physical function in older adults, was implemented using evidence-based strategies. MEASUREMENT: Characteristics (age, race, and sex), health outcomes (comorbidities, instrumental/activities of daily living [I/ADLs], pain, depression, and falls), and emergency department and hospitalization visits preintervention/postintervention and in the usual care cohort were examined. We also measured Medicaid beneficiary's satisfaction with care for those who received CAPABLE. RESULTS: Improved mean ± SD ADLs (preintervention, 8.51 ± 3.08; postintervention, 7.80 ± 2.86; P = .01) and IADLs (preintervention, 6.43 ± 1.31; postintervention, 5.62 ± 1.09; P < .01), a decrease in falls by 14% (from 34.8% preintervention to 20.8% postintervention; P < .01), and fewer hospitalizations (from 0.43 ± 1.51 preintervention to 0.23 ± 0.60 postintervention; P = .03) were found. Post-CAPABLE means were significantly better compared with a usual care cohort for IADLs (6.73 ± 1.27; P < .01) and hospitalizations (0.47 ± 2.66; P < .01). Satisfaction with care was high, and 98.1% recommended CAPABLE as a way to help remain living in the community. CONCLUSION: Improved ADLs and IADLs, a reduction in fall rates, fewer hospitalizations, and high satisfaction with care occurred in this population as a result of the use of CAPABLE. CAPABLE may be one solution to helping vulnerable, low-income older adults with poor physical function to remain living in the community. J Am Geriatr Soc 67:363-370, 2019.



Short TitleJournal of the American Geriatrics SocietyJ Am Geriatr Soc
Alternate JournalJ Am Geriatr Soc