1. Translating CAPABLE to MiCAPABLE in a State Waiver Program: Community Aging in Place for Better Elderly Living Spoelstra, S. L., DeKoekkoek, T., Roth, J.; Evelyn-Gustave, A.; Schueller, M., Szanton, S. PROBLEM  42% of older adults report a functional limitation or disability  Inability to carry out ADLs/IADL’s GOAL  Translation of CAPABLE into MiCAPABLE while embedding evidence into MI Waiver This research was supported by: Translating Evidence into Demonstrations, APP 119646 to Delaying or Preventing Nursing Home Placement in the Home & Community Based Waiver Program in MI, A Medicaid Match Grant; MI Community Aging in Place: Kagan Award; Hartford Foundation Change AGEnts Action Award; BC BS of MI Foundation McDevitt Excellence in Research Award in the area of health policy for research RESULTS  Enrolled 12 at A&D Homecare Saginaw, MI  Characteristics o Mean age: 66.8 years o SD 9.7 o Range 54—90 o 58.3% (n=7) female o Race/ethnicity o 83.3% (n=10) Caucasian o 16.7% (n=2) African American/other  Care: o 7 visits per case o Modified a bathroom and kitchen o Obtained several support aids o Improved QOL: o Caregiver said: “The RN and SW took the time to listen to my husband and understand what his needs were.” o Participant said: “I was able to overcome my anxiety and get out of my house for the first time in 5-years.” STAKEHOLDER BENEFITS  Older Adults: Improved self-care and mobility so that they can remain at home  Families: Easier caregiving process for disabled family members  Organizations: Less admissions into nursing homes  State: save money PRACTICE IMPLICATIONS  Lessons learned:  Design fidelity into electronic health record  Engage policy-makers to lead the charge  Develop clinician Change AGEnts  Challenges:  Difficult to hire OT ; delayed 5-months  Site was challenged to fit training & implementation into workload of 1,100 participants  Paper documentation was challenging  Isolating the specific tasks/actions that SW could/would do in addition to RN  Monitoring fidelity to person-centered, self- direct care was difficult, as waiver staff felt uncomfortable tape recording home visits  Unexpected successes: o Worked closely with intervention designers: opportunity to progress rapidly o Selected for NIH Dissemination and Implementation Science training NEXT STEPS Expand MiCAPABLE Statewide: o Transform MI Medicaid Waiver o Provide evidence-based care o Developed training modules to bring to scale o Rita & Alex Hillman Foundation Grant o Medicaid Match Grants SOLUTION 1.ABLE: Advancing Better Living for Elders (2004) a.6 home visits by OT/PT b.Home modification c.Address client-identified function & home safety 2.CAPABLE: extended ABLE (2010) a.Person-centered & home-based b.Interdisciplinary: i.6 OT visits focused on function ii.4 RN visits focused on pain, depression, medication reconciliation, simple strength/balance training, & PCP communication iii.Pharmacist medication review iv.Home repair to the home modification 3.MiCAPABLE: extended CAPABLE a.Added SW b.Within existing Medicaid Program c.Trained site clinicians: RN, OT, SW, PharmD d.Modified EHR OBJECTIVES 1.Delay or prevent nursing home placement 2.Allow to live at home, where they most want to be 3.Disseminate MiCAPABLE statewide