Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) Program is a successful evidence-based intervention involving an OT, a nurse, and a handyman to promote aging in place for older adults. This presentation reflects important adaptations identified by stakeholders for implementation of CAPABLE through an Area Agency on Aging for a non-Medicaid population and reinforces the importance of early stakeholder engagement in knowledge translation.
Primary Author and Speaker: Pamela Toto
Additional Authors and Speakers: Beth Fields
Contributing Authors: Caylee Yanes
PURPOSE: Nearly 90% of adults wish to age in place (Leamond, 2018). Evidence demonstrates that addressing older adults’ functional limitations and the home environment reduces disability and adverse events, enabling older adults to continue living at home instead of institutional care (Weaver & Roberto, 2017). CAPABLE is a 5 month evidence-based, person-centered intervention delivered in the home by an occupational therapist, a nurse, and a handyman who provide assessment, education and problem solving to help the older adult achieve self-identified goals targeting activities of daily living (ADL), instrumental ADL (IADL) and associated environmental barriers. Studies have demonstrated the effectiveness of CAPABLE in a Medicaid population; reducing disability in older adults; lowering inpatient and long-term service use; and decreasing Medicaid spending for older adults with reported one or more ADL limitation (Szanton et al., 2015; Szanton et al., 2016). Despite this compelling evidence, CAPABLE has not yet been implemented through a AAA for older adults who experience ADL/IADL disability and have limited resources but do not qualify for Medicaid. Therefore, the purpose of this study was to adapt the CAPABLE program for implementation in a AAA and for older adults with ADL/IADL limitations but do not meet thresholds for Medicaid eligibility.
DESIGN: A descriptive qualitative study was conducted and guided by the Cultural Adaptation Process (CAP) Framework.
METHOD: Data collection occurred with key stakeholders from a local Area Agency on Aging in Western Pennsylvania. Two, 60-minute focus groups were conducted with frontline providers (n = 7) and administrators (n = 7). Focus groups provided in-depth perspectives of CAPABLE with respect to benefits, limitations, barriers, and facilitators for implementing CAPABLE in a AAA setting. The focus group moderator and notetaker completed field notes to record concrete descriptions of what was observed during data collection. Thematic analysis of focus group and field note data were completed using NVivo 12 Pro. Analytic memos were created to organize thoughts about data and to aid in interpretation of results. After data analysis, one stakeholder check was performed to confirm accuracy of the information gathered and to ensure that results and next steps make sense.
RESULTS: Stakeholders described three central themes to consider when implementing CAPABLE in a AAA setting: screening and referral process, eligibility, and team meetings. Frontline providers recognized the need to allow care managers ‘to decide who would be most appropriate for the program because they have a better understanding of the person, their family, and home environment.’ Administrators questioned the importance of keeping the original eligibility requirements for CAPABLE, ‘Could we offer the program to someone even if they were hospitalized? I think a lot of people go home and need more training and home modifications.’ All stakeholders expressed that an initial team meeting could be beneficial for goal setting, ‘If the nurse, occupational therapist, consumer and caregiver, and care manager could all be together in-person for the first meeting that could really save time and money and help generate ideas for goals.’ Illustrative quotes from stakeholders’ focus groups and impressions documented in field notes were expounded
CONCLUSION: Stakeholder input revealed the need for distinct adaptations to ensure support and success in implementing CAPABLE with a non-Medicaid population through AAA. These results reinforce the critical importance of stakeholder engagement early in knowledge translation and implementation.
References
LeaMond, N. (2018). Livable Communities for All. AARP International: The Journal, 11, 32.
Szanton, S. L., Wolff, J. L., Leff, B., Roberts, L., Thorpe, R. J., Tanner, E. K., ... & Gitlin, L. N. (2015). Preliminary data from Community Aging in Place, Advancing Better Living for Elders, a patient-directed, team-based intervention to improve physical function and decrease nursing home utilization: the first 100 individuals to complete a Centers for Medicare and Medicaid Services innovation project. Journal of the American Geriatrics Society, 63(2), 371-374.
Szanton, S. L., Leff, B., Wolff, J. L., Roberts, L., & Gitlin, L. N. (2016). Home-based care program reduces disability and promotes aging in place. Health Affairs, 35(9), 1558-1563.
Weaver, R. H., & Roberto, K. A. (2017). Home and community-based service use by vulnerable older adults. The Gerontologist, 57(3), 540-551.
