CAPABLE Helps Veterans Age with Independence and Comfort
This content was originally published October 10, 2022.
The Safer Aging Through Geriatrics-Informed Evidence-Based Practices (SAGE) is a newly funded, five-year Quality Improvement Research Initiative (QUERI) program that aims to improve outcomes for older Veterans across all VA medical centers in the Veterans Integrated Services Network (VISN) 4. Through the implementation of four evidence-based practices, the SAGE QUERI will help VA medical centers become more age-friendly. Each of the four evidence-based practices align with one of the 4 Ms of The Institute for Healthcare Improvement’s Age-Friendly Health System model: “What Matters”, “Medication”, “Mentation”, and “Mobility”. SAGE QUERI’s primary outcome is to increase the number of “facility free days” or days a Veteran spends outside the hospital or nursing home.
The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) program aligns with the mobility aspect of an Age-Friendly Health System. CAPABLE, developed at Johns Hopkins University, is a home-based program that enables older Veterans to age safely in place. CAPABLE is implemented by a team consisting of an occupational therapist (OT), a nurse (RN), and a handy person that work together to help Veterans achieve self-selected goals by increasing self-efficacy through home modifications and education. Through additional grant funding, the VA CAPABLE program will also perform critical home repairs for low-income Veterans. Home modifications and critical home repairs will be done by Serviam Construction, LLC. Serviam Construction, LLC is a service-disabled Veteran and disadvantaged woman-owned small business general contractor that serves all of Pennsylvania. Home modifications include, but are not limited to, installing grab bars, ramps, and stair glides. Critical home repairs include the repair or replacement of major home systems including roofing, siding, windows, heating, and air conditioning, plumbing, or electrical systems.
CAPABLE will be implemented in three waves of three VA medical centers. The first wave consists of the Pittsburgh, Altoona, and Erie VA medical centers. The SAGE QUERI team has worked with leadership and clinicians at each of these sites to determine processes and procedures for the implementation of CAPABLE. At the Pittsburgh and Altoona VA medical centers, home-based primary care OT and RN teams have been trained in the CAPABLE program. CAPABLE at the Erie VA Medical Center will be implemented by Niagara Therapy, LLC and funded fully with outside grant funding. In total, nine clinicians have been trained in the CAPABLE program and three Veterans have been enrolled. The second wave consists of the Philadelphia, Coatesville, and Wilmington VA medical centers. This wave will begin training 12 OTs and RNs in October 2022 and begin implementing CAPABLE by the end of the year.
In August 2022, VISN4 enrolled the first Veteran in CAPABLE-VA. The Veteran was identified and enrolled based on their level of daily function as well as the home modifications and supplies they need to maximize home safety, independence, and quality of life. The Veteran uses supplemental oxygen; this means they must roll a tank around everywhere they go, both in and out of the home. Not only is the oxygen tank heavy, but it is also a finite supply. The Veteran has a fear of falling in the home, which limits their participation in daily living activities, and they do not leave the house because they are afraid they might run out of oxygen while away. Based on the OT and provider recommendations, CAPABLE-VA has supplied the Veteran with an Inogen One G5 oxygen compressor. This device only weighs 5.7 pounds, has a hands-free carrying bag, 13 hours of battery power, and batteries that can be recharged on the go. CAPABLE-VA has given this Veteran their independence. The Veteran can now walk and perform daily activities independently around their home without a fear of falling and they can be out in their community with peace of mind.
