Preliminary data from community aging in place, advancing better living for elders, a patient-directed, team-based intervention to improve physical function and decrease nursing home utilization: the first 100 individuals to complete a centers for medicare and medicaid services innovation project

J Am Geriatr Soc. 2015 Feb;63(2):371-4. doi: 10.1111/jgs.13245. Epub 2015 Jan 30.


Current medical models frequently overlook functional limitations and the home environment even though they partially determine healthcare usage and quality of life. The Centers for Medicare and Medicaid Services (CMS) Innovation Center funds projects that have potential to affect the "triple aim," a framework for decreasing costs while improving health and quality of life. This article presents preliminary data from Community Aging in Place, Advancing Better Living for Elders (CAPABLE), a model funded by the CMS Innovation Center and designed to overcome the functional and home environmental barriers of older adults. CAPABLE is a patient-directed, team-based intervention comprising an occupational therapist, a registered nurse, and a handyman to decrease hospitalization and nursing home usage of community-dwelling older adults with functional limitations who are dually eligible for Medicare and Medicaid. Activity of daily living limitations improved in 79% of the first 100 people who completed the intervention. Preliminary findings of this novel intervention may have implications for other older adults with functional limitations.

Keywords: health disparities; models of care; physical function.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Centers for Medicare and Medicaid Services, U.S.
  • Cohort Studies
  • Female
  • Humans
  • Independent Living*
  • Male
  • Nursing Homes / statistics & numerical data*
  • Patient Care Team / organization & administration*
  • Patient-Centered Care / organization & administration*
  • Quality of Life
  • United States