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Aging-in-Place is Cost Effective and Beneficial

What can a nurse, an occupational therapist, and a handyman do to help elderly people stay in their homes, instead of moving to a nursing home for care? A lot!

A study in the Journal of the American Geriatrics Society describes the benefit of such services to elderly adults who lived in homes in the Baltimore area and participated in a project called CAPABLE. The 2012 study was funded by Centers for Medicare and Medicaid Services Innovation Center with the goal of decreasing Agency costs and improving health care and quality of life for patients. The study shows that such services were successful in keeping 100 percent of the participants out of nursing homes for the follow-up period and that the overall average cost of services such as these is far less than residence in a nursing home.

CAPABLE is a team-based intervention. An occupational therapist, a registered nurse, and a handyman worked together with the elderly patients in home sessions over a 5-month period.

They set goals with the patients to help them function independently and safely in their own home for daily activities and to improve home safety issues, such as safe and accessible entrances and stairs. The participants were followed- up for five months after their participation in home visits by CAPABLE.

The occupational therapists assessed the safety problems in the home, such as fall risks, poor lighting, unstable or uneven flooring, etc. They also looked at how a patient functions in the home, for example, in walking to the bathroom or their safe and efficient movement in a kitchen. They worked with the patient to set goals to improve functioning in the home and to prioritize home modifications and repairs to be done by a handyman. The home repairs and modifications were performed in the first month, and the OT visited the patient again to show the patient how to safely adapt to these modifications.

A nurse also visited to work with participants on depression, strength and balance, medication management, and the ability to communicate with the primary care provider.

Handymen from the AmeriCorps project of Baltimore performed home repairs and modifications, which are budgeted up to $1,300 per household.

As a result of the program, the study says that fewer participants have been hospitalized during the follow-up period than before, and that none of the participants have entered a nursing home. The study states that “the overall cost for each clinical visit, mileage reimbursement, parts and labor for the home modifications, repairs and assistive devices, and clinical coordination between the clinicians averages $3,300.”

And most important, according to the study, the participants were better able to walk and to do their own independent self-care, and experienced less depression emotionally. Home hazards, which often cause falls at home and hospitalization, were significantly reduced for participants.

The study gives even more credibility to the belief that aging-in-place is a practice which is practical and cost-effective, particularly when the elderly are supported with medical and practical help to function in their own homes.

Journal of the American Geriatrics Society, “Innovative Geriatric Practice Models: Preliminary Data.” Volume 63, Issue 2.February 2015. Pages 371–374. Authors: Sarah L. Szanton PhD, Jennifer L. Wolff PhD, Bruce Leff MD, Laken Roberts MPH, Roland J. Thorpe PhD, Elizabeth K. Tanner PhD, Cynthia M. Boyd MD, Qian-Li Xue PhD, Jack Guralnik PhD, and Laura N. Gitlin PhD

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