Johns Hopkins Program Saves Money

John Hopkins’ CAPABLE program certainly does seems capable of saving money.

The Community Aging in Place—Advancing Better Living for Elders (CAPABLE) program developed at the university’s nursing school is designed to keep older people who are frail, have chronic medical conditions or can’t complete activities of daily living in their homes by providing care and help from conventional healthcare professionals — nurses, occupational therapists — but also from people who can do minor house repairs, explains Sarah L. Szanton, the school’s dean.

If a participant can’t stand long enough to prepare food or is no longer able to shovel snow, the program addresses those types of needs as well, she said. Unlike the Program of All-Inclusive Care for the Elderly, which sends healthcare providers to older adults’ homes, the CAPABLE program allows participants to keep seeing their primary care physicians and other members of their care team.

For each dual-eligible participant enrolled in both Medicare and their state’s Medicaid program, a $3,000 investment in the CAPABLE program over five months saves $922 per member per month, according to research published in Health Affairs several years ago. Staying at home yields significant savings compared with the $8,821 average monthly cost of nursing home care, according to Genworth Financial, an insurance company. That could add up quickly considering that roughly 2 million Americans are in nursing homes and some portion of them may be better suited to care at home.

In addition, about 20 million people need more care than they are getting at home because they have trouble completing activities of daily living, says Szanton. “It might be difficult for them to take a shower or to get off the toilet,” she added. “They’re either getting help from a family member or they’re not. And, if they’re not, plenty of people basically sit in the chair all day. I’ve had patients who crawled into their kitchen on their hands and knees because that was the only way they could get there.”

Home-based supportive care is vastly underfunded, partly because Medicaid and Medicare policies are geared more toward institutional care, Szanton says.“ Having presumptive eligibility for institutional care is just backwards,” she says.