A 5-month program involving 10 home visits from healthcare professionals significantly decreased disability in low-income older adults who already had a self-reported disability, according to a randomized clinical trial published online yesterday in JAMA Internal Medicine.

Professionals such as occupational therapists and registered nurses helped participants "identify and achieve their own functional goals through a combination of strategies, including targeting the individual and the home environment," Sarah L. Szanton, PhD, Johns Hopkins University School of Nursing in Baltimore, Maryland, and colleagues write.

The authors tested a person-directed, tailored intervention called Community Aging in Place—Advancing Better Living for Elders (CAPABLE) that aims to improve daily function and meet the needs of low-income.

Occupational therapists and registered nurses

"This well-powered, randomized trial provides further support that the CAPABLE intervention reduces disability scores in a high-risk subset of the older adult population," the authors write."

As such, the program merits consideration of inclusion in payment innovations, such as those from [Centers for Medicare & Medicaid Services; CMS] that allow Medicare Advantage to pay for nonmedical costs with the medical budget or through a Special Needs Plan geared toward people with disabilities who are dually eligible for Medicaid and Medicare."

The researchers note that a previous single-arm study of CAPABLE, costing $2825 per participant, resulted in Medicare cost savings of $22,000 per participant (compared with a propensity score-matched group), according to the CMS Innovation Center. Healthcare organizations in 22 cities and rural areas in 11 states have since implemented the CAPABLE program, the authors write.

The current randomized study involved 300 low-income adults, aged 65 years or older, who lived in Baltimore between March 18, 2012 and April 29, 2016. All participants had a disability "self-reported difficulty with 1 or more activities of daily living (ADLs) or 2 or more instrumental ADLs [IADLs]" — but no evidence of cognitive decline.

Occupational therapists, registered nurses, and home modifiers made 10 home visits during 5 months to the 152 people randomly assigned to receive the intervention. A registered nurse assessed pain, depression, medication understanding, strength, balance, and communication with a primary care provider.

Occupational therapists assessed the participants' disability and home safety before helping them identify functional goals they could achieve with personal changes and changes in the home environment, incorporating strategies brainstormed from the participants themselves.

Environmental modifications may have included home repair or acquiring home medical equipment. Examples included "filling in holes in floors, stabilizing shaky banisters, lowering microwaves to reachable heights, installing tailored bathroom safety equipment, and raising toilet seats," Marlon J. R. Aliberti, MD, and Kenneth E. Covinsky, MD, both from Veterans Affairs Medical Center in San Francisco, California, explain in an invited commentary.