CAPABLE, a home-based care program that provides interdisciplinary services for older adults, leads to reductions in disability as well as cost savings.
Older adults with limitations in activities of daily living (ADL), such as walking, bathing, and eating, experience negative impacts on quality of life and have higher health care costs than those without ADL disability. CAPABLE is a five-month home-based care program that provides older adults with services such as occupational therapy, nursing, and handyman’s services for tailored home repairs and modifications to support living in the community (e.g., ramps, shower grab bars, etc.). As of July 2021, there are 33 CAPABLE program sites across the country and six have published outcomes. This study reviews six randomized trials with peer-reviewed publications or reports on outcomes such as ADLs and instrumental ADLs (IADLs, which are activities that allow an individual to live independently in a community), fall efficacy, depression, pain, and cost savings.
Across all studies, CAPABLE participants demonstrated consistent reductions in ADL and IADL disability. The program improved fall efficacy (confidence in doing ADLs without falling) in four studies that reported this outcome. The Center for Medicare and Medicaid Innovation demonstration of CAPABLE showed cost savings averaging over $22,000 per person while only costing $2,882 per person to implement. As a comparison, another site that implemented the program with fewer nursing visits and home modifications than this demonstration showed more modest savings of just over $600 per person over what the intervention cost. The studies showed mixed results on improving participants’ symptoms of depression and pain.
When implemented fully – six occupational therapist visits, four nursing visits, and up to $1,300 of home repairs — CAPABLE is a cost-effective model that improves preventable disability in older adults and can achieve cost savings. Disability can be modifiable with the proper supports for both the individual and in the home environment, and CAPABLE has been shown to effectively support both of these factors.