For frail seniors, program offers choices and supports to keep them home

With the nation fast graying, a long-term care crisis looms, and too many Americans may not realize that not only will nursing home care be tough to find and afford, it also may be less than ideal. But what happens if seniors themselves — especially the frail old — are asked how care-giving services might best serve them, so they not only can stay in their homes but also enjoy their lives more?

That’s the experimental approach taken by a health care team in Denver, working in the long-titled program, “Community Aging in Place — Advancing Better Living for Elders.” CAPABLE staff intervene with the aged, asking them how, even with disability and debilitation, to improve their lives. The program offers them six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1,300.

What’s different here, as reported by the independent, nonpartisan Kaiser Health News Service (KHN)?

Seniors often say they want to cook meals for themselves, make their beds, use the stairs, get out of the house more easily, walk around without pain or go to church. The [CAPABLE] focus then turns to finding practical solutions. For someone who wants to cook but whose legs are weak, that could mean cutting vegetables while sitting down before standing up at the stove. A bed may need to be lifted on risers and a grab bar positioned between the mattress and box spring so a person can push herself up to a standing position more easily. Or, a nurse may need to go over medications and recommend potential changes to a person’s primary care doctor.

Simple steps like these, like cleaning up the accumulated mess in seniors’ homes, painting them a bit or replacing worn flooring, or helping them get and learn how to use a walker and portable oxygen to restore even some of their mobility, make big differences.

That’s according to researchers who followed up with participants, “300 poor or near-poor older adults, nearly 90 percent women, over 80 percent black, with an average age of 75 and multiple chronic medical conditions such as heart disease, arthritis and chronic obstructive pulmonary disease.”

Here’s what researchers found, according to Judith Graham, a KHN columnist:

For every dollar spent on CAPABLE, nearly $10 in combined savings accrues to Medicare and Medicaid, largely because of hospitalizations and nursing home placements that are prevented, research by [program developer Sarah] Szanton [of the Johns Hopkins Nursing School] and others has shown. (Many CAPABLE participants are eligible for both government health insurance programs because of their low incomes.) The average program cost per person is $2,825, far below the average $7,441 monthly cost of a semiprivate room in a nursing home in 2018.

With support from a New York foundation, advocates — who tested the CAPABLE program in Baltimore and now offer its services there still — hope to expand it beyond its current 26 locations in 12 states. Advocates also want to see if participants can get more and longer services than what they now are offered.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the neglect and abuse inflicted on too many of them, especially the old and the frail elderly, in nursing homes. More Americans than had been believed will spend time in nursing homes, according to research by the independent, nonpartisan RAND Corp. Researchers found that:

 [M]ost people will experience short stays in nursing facilities at a relatively affordable cost. But conditional on having a stay, the average nursing home stay was 272 nights and for 10 percent of the study group, the stay was much longer—more than 1,000 nights. Out-of-pocket spending was similarly skewed, with 5 percent of older Americans needing long stays costing $47,000 or more over their lifetime.

As both RAND research and the KHN story indicate, nursing home care can be costly. It also isn’t easy and convenient to find, especially because the need for it may arise suddenly due to illness or injury. Residents and families also may struggle when what they can afford may not match expectations or needs. But too many seniors, their partners, loved ones, and friends also may not have prepared for the ever-increasing crises with long-term care.

We need lots of pragmatic, affordable, pleasing options to ensure as many Americans get to live truly golden years. Kudos to KHN and CAPABLE for a program that’s showing good outcomes.

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