Home Care Project Combines Services for Big Savings

With a strong focus on enabling seniors to remain in their homes as they age, a project currently under way in Maryland with plans to expand is bundling services delivered in the home and is realizing cost savings in the meantime. 

The project, made possible through grant funding is finding that through a tripod of services including nursing care, occupational therapy and home improvement assistance, seniors can save thousands in dollars spent on more costly alternatives to aging in their homes.

The Baltimore-based project, coined “Capable,” or Community Aging in Place – Advancing Better Living for Elders is modeled after a Philadelphia study, “ABLE,” that was tested in the early 2000s. Those who are 65 and older who qualify for the program by proving difficulty in at least one activity of daily living receive the services of the visiting nurse, occupational therapist and handyman over four months for a cost of about $4,000. About $1,100 of the spending goes to home improvements such as banisters, hand rails and lighting. 


So far, 79 people have enrolled under current grant funding through the National Institutes of Health as well as a separate grant under health care reform through the Centers for Medicare and Medicaid Services. 

The program is administered through the Center for Innovative Care and Aging at Johns Hopkins School of Nursing.

While the program results are not yet available because it is ongoing, initial observations show success not just for those with many needs, but also those who just need assistance with one ADL. 


“We have had surprising success with both sides of the spectrum,” says Sarah Szanton, Associate Professor at Johns Hopkins University School of Nursing and Principal Faculty with the Center for Innovative Care in Aging.”Some almost seemed too functional. They can take a walk, get out, cook; and we think we’re not really going to be able to do much. But we have had great success. [On the other hand], our first participant from CMS had difficulty in every single demand of self care. She went from limitations to all ADLs to not being limited in any of them.”

The cost savings are substantial: the $4,000 over four months that essentially allows a person to remain in his or her home compares with the national median monthly rate for assisted living care of $3,450 or more than $200 per day for nursing home care, according to Genworth Financial’s Annual Cost of Care Survey. The researchers also note the cost is roughly equivalent to one third the cost of a hospitalization for an episode such as a fall or other injury.

The program is limited to Baltimore area currently, but a similar project is being rolled out in Michigan with the potential for more adopters across the nation. Private companies may also take a vested interest in the option, Szanton says. 

“Commercial insurers for long term care want to keep people out of nursing homes,” she says. “You could imagine a model where they pay for it or provide lower premiums if someone has gone through the program.”

Under around $4 million in grant funding, Capable is expected to save $6.8 million over three years. 

Written by Elizabeth Ecker