Mercy Health Muskegon's CAPABLE program keeps clients safe at home
By KATHLEEN NELSON
Little things mean the world to Annie Brown. The 70-year-old lives alone in Muskegon, Mich., and is proud of her independence. She soldiered on even as arthritis pain made reaching for a jar on the top shelf of her pantry or climbing into her bathtub cause for trepidation.
"When you get elderly, you think people have forgotten about you," she says.
Dave McQueen installs a handheld shower head for Annie Brown of Muskegon, Mich., as part of a program that works with senior and disabled clients to keep them living safely and independently at home.
But the team from the CAPABLE program, administered through Mercy Health's Muskegon Health Project, listened to her. Because of the program, Brown has a new shower curtain, bench, grab bar, and peace of mind come shower time.
"Before I had fallen a couple times trying to take a bath," she says. Of the improvements, she says, "I think it's just great, and I really appreciate the work that was done."
CAPABLE stands for Community Aging in Place — Advancing Better Living for Elders. The program provides small modifications in the homes of seniors that can help them safely age in place. The proof of concept came in a research study at Johns Hopkins University in Baltimore in which:
- 79 percent of participants improved their self-care over the course of five months.
- The number of self-care tasks that participants had difficulty with were cut in half.
- Participants experienced a decrease in depressive symptoms similar to that of taking antidepressants.
Mercy Health Muskegon is the only Catholic health care organization participating in CAPABLE, which has spread to a dozen sites around the country, according to the program's principal investigator at Johns Hopkins, Sarah Szanton. The program in Muskegon began in May and is funded through a $349,000 Trinity Health Innovation Grant. It employs a registered nurse, occupational therapist and carpenter, who work with the client to identify and implement small adjustments that will enable the person to continue living independently in his or her home.
Inexpensive fixes
The program is elegant in its simplicity. A few small fixes, such as a grab bar or medication organizer, can be all that's needed for a senior to feel more at ease living independently. The program provides these, with each participant getting up to $500 in products and repairs.
"We work with our community health workers, who could help replace big ticket items (such as) a furnace through our partnership with DTE Energy (a Detroit-based utility company). Or we had a block grant or rural development fund to pay for roof repairs. But when it came to the small things, we couldn't find any money," says Judy Kell, HUB Manager of the Muskegon Health Project's Pathways to Better Health of the Lakeshore program. "These kinds of simple things that are not traditionally reimbursed or thought of within the walls of institutions are really what can keep people in their homes. People are happier in their homes."
Participants start with in-home visits from the occupational therapist and nurse who inquire about their concerns. Tonia Bourdon, the project's nurse, says many participants need instruction in how to set up medication boxes and to understand what their medications are for.
"People also have white coat anxiety," Bourdon says. "They get to the doctor's office, and all their questions and concerns go out the door so they can get out of the office quickly. I'm teaching them to write their questions down and improve communication with the doctor."
Accommodating by design
Both Bourdon and Samantha Long, the program's occupational therapist, agree that CAPABLE's biggest strength is being "client-driven."
Arthritis pain had made some tasks of daily living challenging for Annie Brown, who says she feels more confident living independently in her home now because of small modifications made through the CAPABLE program.
"They are choosing their own goals," Long says. "When I first meet the client, I want to get an understanding of their daily routine: what they like to do, what they do with their leisure time. I love listening to their stories. That opens the conversation to cover more specific things."
From initial interviews and a diagnostic tool developed by Johns Hopkins, Long and the client figure out what changes will make the biggest impact in eight activities of daily living: using the telephone, shopping, preparing food, doing light housekeeping, doing laundry, traveling independently, taking medications and managing finances.
In addition to her worries about bathroom falls, Brown told the CAPABLE crew it was painful for her to retrieve laundry soap or jars on high shelves. The program's carpenter, Dave McQueen, installed a lower shelf for her detergent in the laundry room and provided a grabber and step ladder.
"I feel comfortable in my home," Brown says. "This makes a person feel good."
The team in Muskegon has followed the Johns Hopkins model closely, with one exception. "The community health worker is the secret sauce for us," Kell says, "to be the long-term support for Tonia and Samantha. They can provide links to other services. We think they will enhance outcomes and decrease costs."
Expanding client base
So far, 16 people have been enrolled in Muskegon's CAPABLE program. Between now and September, the program hopes to enroll 100 residents who are seniors or disabled and are on both Medicare and Medicaid. Mercy also will start a parallel program in January at Mercy Health Saint Mary's in Grand Rapids, Mich. The system will report outcomes from both locations to a Johns Hopkins researcher, who will compile data from CAPABLE programs.
"From the system perspective, these are the types of high-impact and low-cost programs that support our goals in population health management," says Stevi Riel, executive director and community benefit ministry officer at Mercy Health Muskegon. "We want to make sure that our patients are as healthy as possible, in their homes if possible, for as long as they wish. I'd love to sustain this program as part of our portfolio of home-based solutions."
Bourdon says: "I've cared for patients in the hospital setting who might not have ended up there or in a nursing home if they had a community health worker or a program like CAPABLE. I see this project keeping people in their homes, out of the hospital and happier in the long run."