Determining what matters to homebound elders.
Sarah Szanton
This month, AJN profiles Sarah Szanton, who created a program known as CAPABLE—Community Aging in Place, Advancing Better Living for Elders—that helps low-income seniors to remain at home with the aid of a unique home care team.
Szanton, an NP who has provided care for homebound elders, notes that “[b]eing in someone’s home gives you the opportunity to see what matters to them.”
The “person–environment fit.”
Szanton’s keen interest in the “person–environment fit” of her frail elderly patients led her to a different perspective on managing illness—one focused less on the “medical model” and more on “function and being able to do what they would like to do.”
In 2008, after the NIH requested proposals for projects to help the newly unemployed, Szanton wondered whether people with home-building skills could be paired with elders to improve their independence and quality of life. And the idea for CAPABLE began to form.
A unique home care team: nurse, occupational therapist, handyman.
CAPABLE’s home care teams are made up of a nurse, an occupational therapist, and a handyman. The patient identifies functional goals such as “to be able to stand long enough to prepare a meal,” and the team devises a plan based on these goals.
Today there are versions of CAPABLE in 13 cities (in both urban and rural areas) in eight states. Research has clearly demonstrated the benefits of CAPABLE teams. In the CMS demonstration projects mentioned in the article, 75% of elders working with CAPABLE improved their ability to perform activities of daily living, and over half experienced decreased symptoms of depression.
In addition, the program has been shown to deliver cost savings as a result of fewer hospitalizations, fewer readmits, and a decreased need for outpatient visits. Szanton notes that these positive outcomes come at relatively low cost because “it’s really just tiny things working together.”
Read more about Szanton and this pioneering program in the October issue of AJN. (The article will be free until October 20.)
Mrs. Todd,
This is a great article, Mrs. Szanton’s idea of empowering the elder patients to have say so in their care is admirable. I strongly believe that “purpose in life” is the best remedy we as humans have to battle illnesses, specially mental illnesses and the loneliness that comes when we get into our golden years. I personally saw what this empowerment can do, as we tried a similar approach with my grandmother a few years back. She was always that person who needed to do everything herself, very independent and strong willed. At first, we tried to do everything for her in order to reduce what we thought was the need for assistance, but soon realized that all off that pampering was doing was slowly removing her sense of ” Purpose in Life”. We then created a plan, as a family, in which she would still use her lifelong acquired skills. It was amazing to all of us how this new implementation changed her mood, improved her health and brought back in her a sense of purpose. I agree that what Mrs. Szanton is trying to accomplish with her innovative ways is a model that should closely be looked by all of those involved in the care of our geriatric population. It is a model that I strongly believe will improve health and mental issues in this population and will reduce the financial burden of all involved parties.
Like the focus on autonomy, home safety, and optimizing functional skills. A individual plan of care for clients is always important..