Johns Hopkins In-Home Aging Program Shows Big Results

Senior living providers might want to pay attention to a promising Johns Hopkins program that proves small changes can make a big difference.

The program, dubbed Capable (Community Aging in Place, Advancing Better Living for Elders), combines three key elements of senior care services: nursing care, occupational therapy services and home improvement. For every $3,000 spent per program participant, the program saves Medicare more than $10,000, according to recent results published in Health Affairs.

One of the most surprising aspects of the program has been its ability to result in big savings through relatively minor investments—like better lighting at home—that can help keep seniors out of outpatient and hospital settings.


Small fixes mean big improvements

To qualify for the program, low-income seniors must report they have trouble with at least one activity of daily living (ADL). Seniors are enrolled in the program for four months and can receive the program’s services over several visits.

The program, which is run by the Johns Hopkins University School of Nursing, is funded by number of grants from the National Institutes of Health (NIH), the Center for Medicare & Medicaid Services (CMS) and the Robert Wood Johnson Foundation. Since its pilot in 2009, the program has reached 700 seniors and expanded from Baltimore to Colorado, Michigan, North Carolina, California, Vermont and Pennsylvania.


The end goal is to increase participants’ overall quality of life on their own terms, says Sarah Szanton, a professor at the Johns Hopkins School of Nursing and the Bloomberg School of Public Health.

Seniors in the program identify functional goals they’d like to achieve, such as walking up stairs without pain, taking a shower more easily or simply being able to leave the house more often. Then, they work with an occupational therapist, nurse and handyman, who are hired locally, to help facilitate those goals.

“If someone has weak legs and has a hard time getting their foot over the tub, it would be a combination of making the tub easier to get into with grab bars plus strengthening their legs and helping improve their mood,” Szanton explains. “It’s really surprising how much small things can make a big difference.”

Up to $1,300 of each participant’s allotment can go toward home improvements, such as new banisters, lower kitchen shelving, better lighting and other household items. The average participant’s home usually needs about 16 different changes.

The remaining $1,700 is put toward occupational therapy and nursing services, such as training on assistive devices, special household instructions or simple motivation and encouragement.

Promising results

Capable’s results so far have been promising; nearly three quarters (74.8%) of 234 studied participants improved their performance with ADL tasks like shopping, preparing food and managing medications, according to health policy journal Health Affairs.

Depression also markedly improved among seniors who took part in the program. Just over half (52.9%) of the studied seniors reported an improvement of depressive symptoms, the data shows.

“That’s really unheard of in the geriatrics literature,” Szanton says. “People over time tend to do worse or stay the same.”

Though the program is currently active in just seven states, it could be implemented across the entire U.S., Szanton says. She advocates for the program to scale by becoming a Medicare benefit or a part of Medicare Advantage plans. Private home care agencies might also be able to adopt the program for their own needs.

“If someone has a little more money and they’ve got three grown kids, if each one paid $1,000, that could go a long way toward everyone’s piece of mind and capability,” Szanton says.

Still, Szanton stresses the big picture objective should be helping people wherever the need is. And there is plenty of need.

“I’m a scientist, not a salesperson, so I don’t have specific goals for scaling that way,” Szanton says. “What I do have are goals for people to benefit from it.”

Written by Tim Regan

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