1. Decreasing health disparities with older adults: The CAPABLE studies
Sarah L. Szanton, PhD ANP FAAN Associate Professor Johns Hopkins School of Nursing Associate Director for Policy, Center for Innovative Care in Aging September 22,2016

2. Mrs. B
Was a domestic for various families. 85 year old. She lives on a block that has many boarded up houses. Can’t negotiate the stairs so her bed is in what used to be the living room. Better shape than many as there is a bathroom on this level. Truck-driver grandson who sleeps at her house sometimes and brings her groceries. She can’t stand long to cook. Mostly by herself. She can’t really get dressed as her clothes are in a plastic storage ____ that is safety pinned together. Can’t easily unfasten the safety pins. Holes in floor. Electrical wires loose on floor.
One might say, why invest in Mrs. B?

4. Her Hazardous floor

6. Relative Risk of Being in the Top 5% of Health Care Spenders, 2006

7. CAPABLE
Focused on individual strengths and deficits and goals in self-care (ADLs and IADL)
Client-directed as opposed to client- centered
Handyman, Nurse and Occupational Therapist
OT: 6 visits, RN:4 visits, Handyman: $1300 budget over 4 months

8. Month 1
Month 2
Month 3
Month 4

9. Before After

10. Exhibit 1. Changes from Baseline to Follow-up in Activities of Daily Living Limitations and Instrumental Activities of Daily Living Limitations

11. Exhibit 2. Changes from Baseline to Follow-up in Depressive Symptoms and Home Hazards

12. Addressing Function Poor function is costly
It’s what older adults care about
It’s virtually ignored in medical care
Modifiable

13. Payor Possibilities CMS committed to scaling if meets Triple Aim
Accountable Care Organizations
Medicare Advantage
PACE
Medicaid waivers
Maryland Hospital Waiver

14. Questions and discussion