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

Sandra L. Spoelstra, Alla Sikorskii, Laura N Gitlin, Monica Schueller, Margaret Kline, Sarah L Szanton

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Abstract

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.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Keywords

  • adaptation
  • evidence-based model
  • implementation
  • Medicaid waiver
  • physical function

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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