The CAPABLE Program: Supporting Aging in Place

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. […]

How Long Should Routine Health Screening Continue in Older Adults?

Photo by Johner Images / Alamy Stock Photo

Communicating to older patients that routine screening tests are no longer recommended can prove difficult. Recent research, however, offers guidance on how nurses and other clinicians should approach such conversations.

As we report in a September news article, a study focused on cancer screening found that older adults unlikely to benefit from certain tests were receptive to recommendations to stop screening, with a caveat: they preferred that life expectancy not be a part of the conversation.

The study’s accompanying editorial notes that broaching the topic of life expectancy can turn a discussion about maintaining health into an unexpected discussion about the end of life, which “may be a shock in the primary care setting at a routine visit.” The authors of the study recommend changing the language used in these conversations—for example, saying “This test would not help you live longer” instead of referring to “life expectancy.” […]

2017-09-06T09:21:09+00:00 September 6th, 2017|Nursing, patient engagement|1 Comment

Intimate Strangers: A Pediatric Intensive Care Nurse Reflects

By Lisa Dietrich for AJN.

“How do I talk about these things with a stranger unless I know how to be intimate?” asks pediatric intensive care nurse Hui-wen (Alina) Sato, the author of “Intimate Strangers,” the Reflections essay in AJN’s August issue.

Sato writes about “walking intimately . . . through the most devastating hours of her life” with a woman she’s only just met—even as her role as a nurse involves ending the life-sustaining treatments of this mother’s child.

Nurses will tell you such experiences can be common in their profession. But essays like this remind us that such experiences are also remarkable. Sato is the type of nurse who ponders her role, who stops after the fact to wonder what it means to be a participant at such moments in others’ lives. […]

2017-08-04T10:51:54+00:00 August 4th, 2017|Nursing, nursing stories, patient engagement|0 Comments

Those Who Comfort Us

There was only a tiny drop of blood. I was worried, of course, but I went to my OB-GYN for reassurance more than anything else. Maybe she would tell me I was doing too much and needed to rest. Maybe it was just normal. But as soon as she looked at the ultrasound screen, I knew.

Usually when I went for a scan, she immediately turned the screen toward me. Until now, every scan had been great. I had just entered my second trimester. The barrage of tests given to women of “advanced maternal age” had all come back normal. The baby’s heartbeat was strong at every visit, and I was riddled with nausea, something I’d been told was a “good sign.”

This time she stared at the screen for what seemed like forever. Then, quietly, she told me that my baby of 16 weeks’ gestation no longer had a heartbeat. Moments later, the high-risk doctor came in to confirm this. I turned away as he talked to my doctor about the “degradation” he could see, suggesting the death had happened over a week before. Somehow this terrible word—and image—is what stuck with me, even weeks after the event.

Later I entered the ambulatory center where I would have a […]

Dialysis Patients’ Very Different Life or Death Choices

Illustration by Barbara Hranilovich. All rights reserved. Illustration by Barbara Hranilovich. All rights reserved.

This month’s Reflections essay is called “Sitting with Death.” The subtitle provides a little context: A social worker on a dialysis unit bears witness to patients’ life or death choices. Despite the sad stories the author tells, this remembrance doesn’t leave a reader feeling disheartened.

Retired social worker Linda Converse writes that starting work at a dialysis center was at first daunting. How could she talk to patients about such an ultimate choice as whether or not to give up dialysis?

But over time she began to understand that there was usually no right answer. For each person, there was a different personal algorithm that guided the choice, one based on such factors as quality of life, obligations to loved ones, values, and much else. Writes Converse:

I’ll never forget some of the patients who chose to stop dialysis, nor will I forget those who chose to hold on for as long as possible. There was no consistent logic when it came to an individual’s choice. What one person considered an impossible quality of life, another wouldn’t.

[…]

2016-12-05T08:57:58+00:00 December 5th, 2016|patient engagement, patient experience|0 Comments