Medicaid Cost Savings of a Preventive Home Visit Program for Disabled Older Adults

Szanton, Sarah L.; Alfonso, Y. Natalia; Leff, Bruce; Guralnik, Jack M.; Wolff, Jennifer L.; Stockwell, Ian; Gitlin, Laura N.; Bishai, David

doi:10.1111/jgs.15143

Cited by 43 publications

(37 citation statements)

References 24 publications

(23 reference statements)

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“…Community programs focusing on function and environment for older people with complex needs have demonstrated improved function, reduced depression and improved motivation to participate in activity (Szanton et al, 2011(Szanton et al, , 2018. Although the low income population studied by Szanton et al (2011) is not directly comparable to an Australian population, findings show early intervention focusing on physical training can improve function, reduce frailty and falls risk, and reduce difficulties with completing ADL tasks.…”

Section: Discussionmentioning

confidence: 99%

Subjective memory complaints and difficulty performing activities of daily living among older women in Australia

Cordier

Chen

Clemson

et al. 2018

Aus Occup Therapy J

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Background/aim Increased age and cognitive decline have been linked to difficulties with activities of daily living (ADL) and instrumental activities of daily living (IADL). Cognitive decline can often be signalled by complaints about one's cognition, such as memory. With older Australians living longer, there is an increasing proportion of the population at risk of declined performance in daily tasks. The aim of this study was to identify if subjective memory complaints in later life among older women predict changes in independence in performing ADL and IADL. Methods Data were from 3721 women born 1921–1926, who completed Surveys 4–6 of the Australian Longitudinal Study on Women's Health. Memory complaints and difficulties on ADL were measured at each survey, using the Memory Complaint Questionnaire and 16 questions regarding specific ADL. Latent growth modelling examined correlations between initial scores on each measure, changes in measures, and the association between memory complaints and changes in ADL and IADL. Results There was a significant association between baseline scores for subjective memory difficulty and baseline ADL and IADL scores. Initial memory difficulty was also associated with increase in ADL and IADL difficulty. Conclusions Subjective memory complaints may be a risk factor for decline in performance on ADL. Attention to these concerns may be important in identifying functional decline in older age.

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Section: Discussionmentioning

confidence: 99%

Subjective memory complaints and difficulty performing activities of daily living among older women in Australia

Cordier

Chen

Clemson

et al. 2018

Aus Occup Therapy J

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“…Expanding upon ABLE, CAPABLE is a 16-week structured program delivered by OTs who conduct six home visits and provide assistive devices, RNs who conduct four home visits, and a handyman who provides home alterations (ie, installs devices, makes environmental modifications, and performs home repair). [15][16][17][18][19] Similar to ABLE, the CAPABLE interdisciplinary team provided consultation with older adults to help them identify daily activity goals (eg, taking a shower and walking to the bathroom), evaluated barriers to achieving those goals, and attained outcomes collaboratively. 11,18 The OT assists older adults to perform ADLs, instrumental ADLs (IADLs), and discretionary activities that are challenging at home, such as functional mobility, meal preparation, bathing, and dressing.…”

Section: Model Descriptionmentioning

confidence: 99%

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

Spoelstra

Sikorskii

Gitlin

et al. 2018

J American Geriatrics Society

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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.

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“…Nurse practitioners are featured as team leaders in the Geriatric Resources for Assessment and Care of Elders team care model, an early and successful care model implemented and evaluated extensively in lower income older adults in an urban setting very similar to the CAPABLE study sample . In CAPABLE, registered nurses were used as team members; although they have a more limited scope of practice than nurse practitioners, their focus in CAPABLE is on assessment of older adults’ health problems, goal setting, and communication with office‐based primary care providers . Handyman services are a creative addition to an in‐home care team focused on optimizing function and adds a novel dimension to the definition of the direct care workforce that must grow to meet ever‐increasing demands of an aging society …”

Section: Organizational Considerationsmentioning

confidence: 99%

“…In this issue of the Journal of the American Geriatrics Society , Szanton and colleagues reported that an in‐home, multidisciplinary team intervention targeting risk factors for functional decline called the Community Aging in Place, Advancing Better Living for Elders (CAPABLE), was associated with significantly lower Medicaid expenditures . The focus on Medicaid costs was highly appropriate because this study enrolled only older adults who were dually eligible for Medicare and Medicaid.…”

mentioning

confidence: 95%

Targeting Function at Home in Older Adults: How to Promote and Disseminate Promising Models of Care?

Fortinsky

Robison

2017

J American Geriatrics Society

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Medicaid Cost Savings of a Preventive Home Visit Program for Disabled Older Adults

Abstract: CAPABLE for Frail dually eligible older adults NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495.

Cited by 43 publications

References 24 publications

Subjective memory complaints and difficulty performing activities of daily living among older women in Australia

Subjective memory complaints and difficulty performing activities of daily living among older women in Australia

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

Targeting Function at Home in Older Adults: How to Promote and Disseminate Promising Models of Care?

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