National program launched at Hopkins Nursing helps seniors age at home

It began in 2009 with a simple idea that came to Sarah Szanton while she was making house calls as a visiting nurse in West Baltimore: helping older adults age in community should increase their well-being and decrease the costs of unnecessary admissions to nursing homes and hospitals.

So Szanton started with 42 elderly Baltimore residents in an NIH-funded pilot clinical trial that dispatched an unusual team for in-home visits. Health care professionals and home repair workers set out to improve participants' physical movements and their physical surroundings so they could age in homes that fit their specific needs.

A 2012 grant from the National Institutes of Health's National Institute on Aging launched a definitive clinical trial with hundreds more. Several grants followed as the program blossomed, proving that its $3,000 cost per person results in $30,000 in savings from avoiding medical costs and nursing home admissions.

A dozen years later, the program—Community Aging in Place, Advancing Better Living for Elders, or CAPABLE—has helped thousands of older Americans in 45 rural, urban, and suburban sites across 23 states and two countries. It no longer requires NIH support. And some states—Massachusetts, Vermont, and Colorado—support the intervention through their Medicaid programs.

"NIH has been vital to CAPABLE's creation, development, testing, and dissemination across the country," said Szanton, now the dean of the Johns Hopkins University School of Nursing. "You can think of it like this: A researcher's idea is like a seed; the university is the ground where the seed is planted; and the NIH provides the water and sunlight to help it grow."

Today, through CAPABLE, older adults spend four months working with a nurse and an occupational therapist to improve their mobility and overall health while a handy worker modifies their homes to accommodate various disabilities.

Szanton tells the story of one 79-year-old man who had suffered nerve injuries from a tour during the Vietnam War. At first, the man greeted CAPABLE team members with a "flat affect, no smile, and no twinkle in his eye," she said.

"You would look at him and see he was depressed," Szanton said. "But one thing that brought him joy was to go out on his back stoop and listen to the birds."

The only way he could do that was for his grandson to lift him out of his wheelchair and carry him out back. The man only left his home three times a week for dialysis.

"One of his goals was to shave standing up and to go outside to listen to the birds without help," she said.

After four months of working with a nurse and an occupational therapist, the man became stronger and more mobile. And with the addition of various bars built into the halls of his house, he could move around without his grandson's help. Before long, as his pain diminished and his strength grew, the man was able to shave standing up and to walk outside to listen to the birds.

"It was very meaningful for his dignity," Szanton said. "He started to leave the house himself for other activities, and by the end of the four months he had a twinkle in his eye and a ready smile for the occupational therapist and the nurse.

"And that's just one story," she added. "This program is so rewarding. I can tell you a thousand stories like that."

Other people have utilized the intervention to navigate stairs to get outside, to walk to the refrigerator for food, to stand at the stove to cook, and to climb into the tub for a bath. Thousands of other older adults who have benefited from CAPABLE never would have had such opportunities if it hadn't been for a single NIH grant recognizing the promise of one researcher's vision more than a decade ago.

Now programs like CAPABLE are helping to refashion the U.S. health system away from sick care toward preventive care. In October 2022, the School of Nursing turned over the CAPABLE national hub to Care Synergy, a network of hospice, home health, and palliative care that has been expanding the intervention across the nation.

"The importance of NIH research is not just in the moment," Szanton said. "It impacts for years."