Community Aging in Place, Advancing Better Living for Elders: Understanding CAPABLE

Keeping older Vermonters in their homes is one of Age Well’s primary goals, and we provide many programs that enhance independence, safety, and well-being, such as Meals on Wheels, In-Home Volunteer support, and CAPABLE – Community Aging in Place, Advancing Better Living for Elders.

What is the CAPABLE Program?

CAPABLE is an evidence-based program developed by the Johns Hopkins School of Nursing. CAPABLE pairs eligible individuals with a team consisting of an occupational therapist, a registered nurse, and a handyperson to help them set and achieve personalized self-care goals.

To get an inside look at the program, we spoke with Ela Dupont OTD, OTR/L, CAPS, ECHM, about her experience as an occupational therapist and CAPABLE specialist.

How do the OTP, nurse, and handyperson work with the client to identify goals in the CAPABLE Program?

Ela describes the interprofessional relationship as a four-person team, with the client at the center of all decision-making. “It’s very person directed. The client selects the goals. For every client, I go in and spend two visits getting to know them, and the nurse spends a visit getting to know them, to figure out how we can work together to support their needs.”

How many times will the CAPABLE team visit during the program? How long does the CAPABLE Program last?

“The team usually conducts 10 visits over the course of four to five months to help someone achieve their goals. Typically, a client will set three goals with the occupational therapist and three goals with the nurse. Sometimes a goal might be weighted a little more heavily than another, based on what the person wants to work on.

“And then the OTP, nurse, and handyperson work together to figure out, OK – What are you going to do? What am I going to do? Let’s not overlap, but let’s work together to make sure we are reaching the goals.

“For example, say someone wanted to be able to prepare meals more independently. “The occupational therapist would work with that person to come up with a strategy and help provide them with whatever tools they might need to cook independently. Then, the nurse would come in and help the client manage any depression symptoms or pain they might be experiencing, or other things that might be keeping them from cooking. The handyperson would visit and implement a modification plan for anything the nurse or OTP noticed in the person’s home that might need repairs. Whether it’s drawers or cabinets that are broken, or a floor that isn’t safe for them to stand on in front of the stove – the handyperson would fix that. Sometimes people need lighting under their cabinets so they can see – they just need a little more lighting in a space.

“So, we would work together to implement all our interventions, and we would make sure that the client knows how to use everything that we put in place, so they can practice cooking on their own. Then we would come back and solve any problems with the client until we hopefully help them achieve their goal of being able to independently cook a meal.”

 Is CAPABLE a function focused program?

Functional tasks relate to how we go about our day-to-day activities: eating, walking, brushing our teeth, or moving around the house. CAPABLE seeks to help those who are experiencing functional limitations or restrictions in their ability to perform physical or mental tasks.

“We have the ability in the CAPABLE program to be very holistic. We can look at every area of function,” Ela shares. “People who have functional limitations and chronic conditions are four times more likely than the general population to be the people who use healthcare services the most. And in typical medical model services, function is not usually addressed.

“I think that CAPABLE’s focus on function is unique compared to other programs, because it really addresses the things that help people in their day-to-day lives and that helps decrease hospitalization. It helps people learn how to problem-solve, get a resource, do something differently… because we’ve helped them learn that skill in the program. That helps clients develop confidence about completing tasks of daily living without falling, reducing costs related to hospitalizations and nursing home visits.

“Whether it’s walking downstairs to take a shower or getting dressed, whatever their goals are – the client is in charge of the direction of the program. The occupational therapist, registered nurse, and handyperson support the client, and we often use motivational interviewing and other types of behavioral techniques, like action planning, to help them achieve their goals.”

What is motivational interviewing?

“Well, one thing to keep in mind is that you can’t force someone to change. For example, someone may come home from the hospital with COPD, and they don’t want to stop smoking. They’re not ready to change.

“Through motivational interviewing, we can explore barriers to change that our clients may face. While we are getting to know the client, we try to show them different ways of thinking or doing things or approaching problems that will help them achieve whatever it is they hope to achieve. It requires a lot of patience, and it requires a lot of skills, open-ended questions, listening, and non-judgmental acceptance.”

What are some examples of home modifications implemented through the CAPABLE Program?

“There are so many simple things we do. We do so many things that aren’t ripping into walls and tearing things down. You know, we’ve certainly made some traditional home modifications, like ramps. We’ve cut into people’s tubs so they can get into them easier, without lifting their legs up and impacting their balance, to prevent falls. But some of the smaller changes we’ve made have been just as impactful.

“For example, one person had not used their couch for five years because it was too low to the ground. We implemented sofa risers – that’s a $4.99 fix. Now, they can sit on their sofa instead of sitting in their bed, which is where they had spent the last five years. That’s huge for someone’s mental health. The quality of life, not feeling like you’re bed-bound because you can’t sit on any other surface in your house.

“We’ve raised a laundry machine so that it’s easier for someone to access and they’re less at risk of falling when they’re going into their laundry for a front loader. “We have also rebuilt some stairs for a condo association because they were unsafe. The client who lived there walked to the grocery store, to the post office, and went out walking with his friend. They needed a safe way to get up and down from their parking lot.”

Can I become a CAPABLE handyperson?

If you are interested in providing home modifications to older Vermonters in need, please contact the Age Well volunteer department.

Ela shared a lovely anecdote about an Age Well CAPABLE volunteer: “We have this one fabulous volunteer who will build us just about anything we ask for. He’s an amazing woodworker, so he’s built these beautiful wooden stools to help people get in and out of bed. If someone is unable to get in and out of bed – this is a barrier to change. People don’t want to appear sick or unwell, they don’t necessarily want medical equipment in their house, and so this volunteer builds these gorgeous and functional stools that really help people. He will custom-make them to whatever dimension the client needs. He will paint them whatever color they want. He will design them however they need to be designed.”

Above: Two wooden stools, volunteer-made for the CAPABLE program.

That is truly incredible, and a very “Vermont” response – to hand-make a wooden stool for a neighbor.

“It’s an amazing resource to have in our back pocket.

“Another fun thing we use is the Amazon Echo devices. We program them with routines to help people remember to take their medications or other kinds of memory cues they might need. They’re like a little reminder service that is in your house. You can also use Alexa for leisure – she tells jokes. And you can get her to play some music for you.

“So, I help people with writing down their favorite channels, you know – if you like ‘70s country rock, they’ve got a station for that!

“We help the client write down the commands for them that they can ask for things that are funnier – ‘Alexa, tell me a joke,’ ‘Tell me about the weather,’ ‘Create a morning routine.’

“It’s so helpful and it’s only $100, as long as the person has access to Wi-Fi. It really provides a sense of security. Instead of someone’s daughter worrying and calling four times a day, Alexa’s reminding the client to move through their daily tasks.”

Are people often willing to engage with technology like Alexa?

“I will say that usually I introduce the idea in the first two visits. If it seems like something’s going to happen, people will warm up to it or they won’t. But the people that warm up to it are usually pretty receptive. So, Alexa tends to be something that we would implement early on, so that they can practice using it with me around. That way, we can troubleshoot and solve the problem together. Problem-solving is part of the CAPABLE program, and having someone to solve problems alongside you is very helpful.

“We are especially lucky in Vermont that we have the support of the Vermont Assistive Technology Program. They’ve been a really great partner with the CAPABLE program in that they have these trial centers that you can bring your clients to, and they can trial all these different pieces of technology, not just the Alexa unit that I was talking about, but they have things like amplified phones and electronic medication systems, and people can try out and see what’s going to work best for their specific situation. And then they often will lend it to the client so they can try it in their house.

“I’ve had the chance to do a couple of visits to the Vermont Assistive Technology Program Tryout Center with clients to help select the right equipment and then come back and implement it in their house. And that has been an amazing way to get people to really try something new.”

How can people learn more about CAPABLE, either for themselves or a loved one?

“The CAPABLE program is tailored to each individual, whatever their strengths are, whatever their goals are, whatever it is that they want to do. We tailor the program to them. And so, we don’t go into someone’s house assuming anything.

A man who is interested in the CAPABLE Program sitting in a chair next to a walker

“We’re not going to assume their goals. We’re not going to assume their strengths. It’s about what it is that they want to do and how we can get them there.

“Everyone in the CAPABLE program gets the same number of visits. They get the same amount of potential goals, but then we completely tailor everything to the older adult. So, if someone wants to make meals without pain and shortness of breath, then we’ll work on that. Someone may want to work on walking down the stairs or getting out to the post office, and we’ll work on figuring that out.

“I think that because the CAPABLE Program is so individualized, it would benefit almost anyone.”

If you are interested in learning more about the CAPABLE program, please call our Helpline: 1-800-642-5119.

Learn more by visiting our CAPABLE webpage: https://www.agewellvt.org/services/home-care-coordination/capable/