Fully CAPABLE: Expanding an Aging-in-Place Program

Nearly all of us want to stay in our home as we age. 

There are benefits to doing so. Our family and friends are more likely to be nearby. We know where to find our favorite activities. After years of appointments, our health care providers can more easily notice changes and anticipate needs. It often costs less to make changes that increase our home’s safety and accessibility than to move.  

Yet it’s not always easy to “age in place.” 

Beth Fields, PhD, OTR/L
Beth Fields, PhD, OTR/L

“As people age, they’re more likely to experience physical and cognitive decline, as well as symptoms that are associated with chronic conditions that often result in functional impairment. Any of these changes can ultimately impact their safety and ability to age in place,” says Beth Fields, PhD, OTR/L, an assistant professor in the University of Wisconsin–Madison Occupational Therapy Program. 

“Addressing older adults’ functional limitations as well as their home environment can help people age in place, rather than move into institutional care-type facilities,” says Fields. 

Fields is part of a multi-state collaboration to expand access to a program that’s been shown to help older people stay in their homes. It’s called CAPABLE, an acronym for Community Aging in Place–Advancing Better Living for Elders, and was developed at the Johns Hopkins School of Nursing.  

“CAPABLE is an evidence-based, person-centered program that is delivered in the home by an interprofessional team consisting of an occupational therapist, a nurse, and a handyman,” says Fields. 

The team visits CAPABLE participants at home, for an hour to 90 minutes at a time, up to ten times. During visits, the team works with older people to assess needs, set goals related to activities and home safety, and solve problems together. 

Fields and her colleagues are working to adapt CAPABLE to include older adults’ family caregivers, and broaden access beyond the program’s current audience of older people with Medicaid coverage. 

“We know that many older adults turn to caregivers for support,” says Fields. “Caregivers often help with household chores, self-care activities, as well as complex medical and nursing tasks.” 

Fields and her colleagues aren’t making assumptions.  

During telephone interviews, they’re asking family caregivers “what role, if any, they would like to have in CAPABLE,” says Fields. They’re asking both older people and their caregivers about “their perceptions of the relative advantages or disadvantages for including and engaging caregivers in those ten home-based sessions of CAPABLE.” 

To broaden CAPABLE’s reach, Fields is working with an Area Agency on Aging in Pittsburgh. Often referred to as AAAs, or triple-A’s, these organizations are designated by their state to plan, develop, coordinate, and deliver programs for older people in their region. 

“We know that many older adults turn to the triple-A for services and supports,” says Fields. She hopes that by working with triple-As, the CAPABLE program will reach “older adults and their families who do not qualify for Medicaid but cannot afford private services.” 

“Earlier this year, we conducted two 60-minute focus groups with frontline providers, many of whom were case managers contracted through the triple-A, as well as leadership within the triple-A,” says Fields. “We’re learning from front-line providers and triple-A administrators how older adults and caregivers could be referred to CAPABLE as a sponsored service. We’re also asking if they anticipate any workflow challenges related to offering CAPABLE.” 

Fields and her colleagues are now analyzing that focus group data. They will report back to triple-A contacts with their initial analysis, to ensure that it accurately reflects their perspectives. 

“We plan to involve the triple-A as much as possible, to ease their implementation of the CAPABLE program,” says Fields. “We hope to offer in-service trainings at other triple-As, to scale up offerings of CAPABLE. It’s all about improving the reach, engagement, and effectiveness of this person- and family-centered approach to support aging in place.” 

–Diane Farsetta